The Center for Podiatric Care and Sports Medicine

Anesthesia during Foot and Ankle Surgery: We Discuss Local, General, Conscious Sedation, and Nerve Block Anesthesia

Posted by on Monday, October 26th, 2015

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When patients are scheduled for foot or ankle surgery, a few of the chief concerns are typically: “What kind of anesthesia will be used?” and “How much will this hurt?” It’s only natural to worry about the physical and psychological impact of surgery. One of our chief concerns at The Center for Podiatric Care and Sports Medicine in NYC is to reduce your pain and suffering throughout the healing process. While each patient’s case is different, this article will cover the basic types of anesthesia used in podiatric surgery to give you an idea of what to expect.

foot surgery anesthesia
There is no need to worry about podiatric surgery with so many anesthesia options available. Image Source: Wikimedia.org

Local and Regional Anesthesia

Used for: Most forefoot and minor rearfoot surgeries, such as bunionectomies, hammertoe correction, neuroma excision, heel spur removal, and ingrown toenail surgery

What it is: Local anesthetic drugs temporarily prevent the conduction of nerve impulses to create a reversible loss of sensation and function. With local anesthesia, a series of injections are administered at the toe, ankle, or knee to numb a very specific area. Regional anesthesia numbs a larger area — like the entire leg, for instance. Patients remain fully awake, cognizant and mentally aware of what’s going on. You will be able to feel the doctor’s touch or tugging, but you will not feel any pain. The effects wear off several hours after surgery.

Pros: Using this form of anesthesia alleviates temporary mental confusion and serious risks like stroke, heart attack, lung infections, and respiratory failure that accompany general anesthesia. While these reactions are rare, they are more likely among smokers, obese patients, sleep apnea sufferers, those with drug allergies, or people with a lot of other medical issues. Other perks include: high patient satisfaction and reduced costs.1http://www.scpod.org/podiatric-surgery/can-foot-operations-really-be-performed-under-local-anaesthetic/

Cons:  Not everyone wants to be “awake” during surgery due to mental anxiety and fear.

Peripheral Nerve Block Anesthesia

Used for: Midfoot and rearfoot traumas requiring more advanced reconstructive work and tendon repair

What it is: Peripheral nerve blocks are a popular type of local anesthetic that provides good operative pain relief with minimal side effects and even reduces the need for post-operative painkillers. The popular popliteal block (administered behind the knee) can provide up to 50 hours of anesthesia. Sometimes ankle blocks, spinal blocks, and epidurals are administered to numb the nerves leading to the lower extremities.

Pros: Since the need for post-operative painkillers is reduced, the risk of gastrointestinal upset is decreased as well. Patients who need to wear an ankle or mid-calf tourniquet do not feel pain or significant discomfort.2https://www.asra.com/page/41/regional-anesthesia-for-surgery Studies show there is less blood loss and fewer complications with this form of anesthesia, compared to general anesthesia.3http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1356143/

Cons: Due to the long-lasting nature of some anesthetic drugs, patients will need a care provider to help them get around for the first few days. Patients are also mentally conscious during the procedure. Side effects may include: headaches, trouble with urination, and serious allergic reactions.

Conscious Sedation

Used for: A variety of procedures, as needed

What it is: Often, podiatric surgeons will use a mild sedative administered through an IV, in addition to local anesthesia, during longer surgeries to lessen the mental burden on the patient. Individuals can still respond to basic commands and prompts, but are kept in a more relaxed state of mind.

Pros: Lessens anxiety, fear, and discomfort

Cons: Conscious sedation is not designed for use during longer reconstructive procedures and also does not impact pain at the site, so it must be used in combination with a signal-blocking or nerve-blocking agent. Side effects may include: nausea, vomiting, drowsiness, and headaches.

General Anesthesia

Used for: Joint replacement or fusion, calcaneal osteotomy, Achilles repair, tendon reconstruction, and fracture repairs

What it is: General anesthesia acts on the entire body, including the nervous system and the brain, to put a person into a deep, unresponsive sleep. It may be administered through inhalation or injection. A licensed anesthesiologist will continuously monitor your heart, blood pressure, body temperature, and respiration, since general anesthesia slows the heart and breathing rate. A tube is placed down the throat to keep airways open. Sometimes general anesthesia is used along with a poplital block.

Pros: Patients are completely asleep and unaware of everything going on. They simply wake up when it’s all done.

Cons: General anesthesia also causes blood vessels to dilate, which can result in heavier blood loss. Common side effects include: sore throat, hoarse voice, headache, nausea, vomiting, and drowsiness. Most people have no trouble with general anesthetics, but poor candidates for surgery may have the risk of lung infection, stroke, heart attack, and death. It is also more expensive to administer and you will need someone to stay with you for the duration of your surgery and drive you home.

Tips On Choosing The Right Anesthesia For Foot Surgery

Patients are often tempted to joke, “Just put me out, Doc,” but they should consider the following questions:

  • Have you (or a family member) ever received anesthesia before and had a reaction?
  • Do you smoke, drink, or use recreational drugs?
  • Are you overweight?
  • Are you being treated for heart, respiratory, or circulatory issues?
  • Do you have any drug allergies or a history of drug side effects?
  • Are you taking medications, nutritional supplements, vitamins, or herbal remedies?
  • Do you have a history of extreme mental anxiety, fear and low pain tolerance to warrant heavier anesthesia?

From a patient’s perspective, some people like that the regional anesthesia gets them through the first 24-48 hours without pain or the use of medication. Other people say they experienced a “pins and needles” sensation as the block wore off that they didn’t like. Some people respond really well and come right out of general anesthesia, while others suffer episodes of vomiting, nausea, headaches, and faintness that make the experience unpleasant. We’ll work with you to determine the option with the maximum efficiency that also has the lowest risk of unpleasant side effects based on your medical history.

Choosing highly experienced, board-certified podiatric surgeons from The Center for Podiatric Care and Sports Medicine in NYC is a good start, but understand that risks are involved with any kind of surgery, no matter how skilled your team is. Contact us for a patient consultation that will cover anesthesia choices particular to your situation.

 

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1. http://www.scpod.org/podiatric-surgery/can-foot-operations-really-be-performed-under-local-anaesthetic/
2. https://www.asra.com/page/41/regional-anesthesia-for-surgery
3. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1356143/

If you have any foot problems or pain, contact The Center for Podiatric Care and Sports MedicineDr. Josef J. GeldwertDr. Katherine Lai, Dr. Ryan Minara and Dr. Mariola Rivera have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.