Background and aims Elective foot surgery is often conducted in the day-case setting and ultrasound-guided ankle block can facilitate anaesthesia, analgesia and early discharge. However, information about patient understanding of nerve blocks and awake surgery is limited. We aimed to understand patients’ expectations and experience of undergoing awake surgery under ankle block.
Methods Local clinical governance team confirmed ethical approval was not required. Oral and written information was given before obtaining informed consent from 23 patients undergoing foot procedures. An experienced anaesthetist performed the ultrasound-guided ankle blocks using 0.75% ropivacaine. Demographic data was collected. Patients were telephoned 48 hours later and interviewed using a semi-structured questionnaire.
Results 20 patients (87%) received sedation with titrated doses of intravenous midazolam. 3 patients (13%) required intra-operative supplementation with local anaesthetic infiltration by the surgeon. No patients required conversion to general anaesthesia (GA). 21 (91%) patients were day cases. Only 5 patients (22%) reported discomfort with block insertion (see image) and intra-operative experience was positive for the majority (87%). Block duration was variable (range: end of operation to 60 hours later). Most (78%) felt pain on block regression was acceptable but 5 (22%) patients experienced difficult pain management. Patients appreciated avoiding GA: ‘no nausea’, ‘not woozy.’ Some reported pre-operative apprehension. However, all patients said they would have the same anaesthetic technique again.
Conclusions A predominantly positive patient experience is encouraging. Pain management on block regression can be challenging. Awake surgery remains a source of pre-operative anxiety, and we are planning further pre-operative education including consent clinics as a potential solution.
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