PURPOSE:Studies assessing intraoperative pain during surgery with wide-awake local anesthesia typically use a unidimensional pain scale, which provides a limited view of the pain experience. The present paper describes two studies that assessed qualitative aspects of intraoperative pain using a multidimensional pain measure. METHODS:The first study was a retrospective survey of 24 patients who received a variety of foot and ankle procedures under wide-awake local anesthesia. Patients completed a copy of the Short-Form McGill Pain Questionnaire (SF-MPQ) through the mail an average of six months following surgery. The second study was a prospective assessment of 40 patients receiving forefoot procedures under the same anesthesia. Patients completed a copy of the SF-MPQ directly after the surgery. RESULTS:Patients in the first study selected an average of 1.17 pain descriptors (SD = 3.02) on the SF-MPQ, whereas patients in the second study selected an average of 1.90 pain descriptors (SD = 1.82). In general, both studies found that sensory descriptors of pain (e.g., sharp, shooting, tender) were more common than affective descriptors. However, mean intensity ratings were low for all descriptors. CONCLUSION:The results of these studies provide a more comprehensive understanding of the patient experience during surgery with wide-awake local anesthesia.

Background: A recent case series suggested that surgery with wide-awake local anesthesia is tolerated well by most foot and ankle patients. However, patients were assessed retrospectively and there was no comparison group to show the relative efficacy of this approach. The present study was conducted to address these concerns. Methods: Perioperative pain and anxiety were assessed in 40 patients receiving forefoot surgery using either wide-awake local anesthesia or general anesthesia. Ratings were collected on the day of surgery using 11-point (0-10) numerical rating scales. Results: Patients in the two anesthesia groups reported no differences in preoperative pain (p = 0.500) or anxiety (p= 0.820). Patients who received wide-awake local anesthesia reported lower levels of postoperative pain (p < 0.001) and anxiety (p < 0.001) than patients who received general anesthesia. They also reported little pain (M=0.17, SD= 0.32) or anxiety (M=1.33, SD= 1.74) during the operation. Conclusions: Results indicate that surgery with wide-awake local anesthesia is tolerated well by most patients, and that it may have some benefit compared to surgery with general anesthesia. (C) 2017 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.