Bunion under local only

[Creflo]

So I had minor surgery recently and requested no anesthesia except local. It was fine. I appreciated not being groggy and not subjecting myself to multiple drugs. What about doing, say, an Austin bunionectomy this way? Has anyone tried this? Of course, the patient would need to prefer it done this way.

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[ldsrmdude]

So I had minor surgery recently and requested no anesthesia except local. It was fine. I appreciated not being groggy and not subjecting myself to multiple drugs. What about doing, say, an Austin bunionectomy this way? Has anyone tried this? Of course, the patient would need to prefer it done this way.

I've never seen a bunion done local only, but sure, why not? I saw a ganglion excision under local only - patient preference- and we've had to do a few I&D's, amps, etc. under local only in really sick patients.

 

[NatCh]

I've done Austin bunionectomies under local-only, both in the O.R. and in the office (not in a very long time though). I prefer to do them under MAC in an O.R. but yes, you can do them under straight local. "In the old days" when it was hard for DPMs to get O.R. privileges a lot of guys did surgery in the office. I had a rotation as a student where the program director would not or could not use an anesthesiologist so we did everything under straight local, and the patients in that community tended to be a bit spazzy so things got "interesting" often.

Some drawbacks to doing a bunionectomy under straight local are that the patient is less comfortable and may give you a moving target while you're trying to work. If you use a tourniquet the patient is more aware of it and they may feel pain from the exsanguination. If you run into any challenges during the procedure and the patient picks up on it then they may get anxious. If your patient doesn't like the sound, smell, and feel of the saw going though their bone they might get uncomfortable. The benefits are that they're less groggy post-op and they have less anesthesia risk.

 

[dyk343]

Did one very recently with my attending. Patient ate/drank prior to showing up to surgery. Anesthesia obviously refused MAC/general. We told patient we would have to do local only or reschedule. Patient opted to have procedure done. The patient was asking a lot of questions intraoperatively and it was quite distracting.

 

[Creflo]

Thanks for the replies. The more I think about it, it just does not make sense to me that we would administer a drug for tourniquet pain that is 20 times more potent than heroin. Especially when we have an adequate block. I guess anesthesia doesn't want me to tell them how to do their job any more than I want them to tell me how to do the bunion.

 

[darazon]

I had the same experience, pt came into pre-op drinking a Sprite. It was forefoot surgery, so they elected to try local. I will never do that when I'm out of residency, it was brutal. The procedure took twice as long ans the pt was a disaster the entire time.