A Patient’s Guide to Anaesthetic Options for Foot and Ankle Surgery

Your anaesthetist will meet you on the morning of your operation and they will discuss the anaesthetic options with you and advise which is suitable for you and the operation you are having. This is the time to ask questions and tell the anaesthetist about any worries you have.

To help prepare you for your surgery, it is helpful to know the common types of anaesthetic options available:

General anaesthesia

• A general anaesthetic produces a state of controlled reversible unconsciousness – i.e. “asleep”

Regional anaesthesia

• Nerve block
• Spinal anaesthesia

Both these types of regional anaesthesia involve the use of local anaesthetic medication to numb particular areas of the body affected by the surgery, and these techniques may be used in combination with a general anaesthetic or sedation.

• General anaesthesia provides a state of controlled reversible consciousness. It is essential for certain operations

• You will first get a cannula (a plastic tube) inserted into the back of your hand

• You are often given oxygen via a clear mask placed on your face before you go to sleep

• The anaesthetic medication will then be injected via your cannula and this will cause you to become unconscious, and go to sleep

• Once you are unconscious, your anaesthetist stays with you at all times and continues to give you anaesthetic agents to keep you unconscious until the operation is complete

• A breathing device will be placed in your throat when you are asleep to allow oxygen and anaesthetic agents to move easily into your lungs

• If you have been given drugs to relax your muscles, you will not be able to breathe for yourself, and a breathing machine (ventilator) will be used

• Advantage: Once the surgery ends, the anaesthetic is stopped and you regain consciousness.

• Disadvantage: A general anaesthetic alone does not provide pain relief, so you will need strong painkillers during and after the operation, for example, morphine like medication

• Possible complications: These include sickness (which can be treated with anti-sickness drugs), sore throat (which can be treated with pain relief drugs), shivering and blurred vision (improves rapidly), difficult breathing at first (which usually improves rapidly), and drowsiness or confusion (which are more common in older people, but are usually temporary).

• There are two major nerves which travel down your leg, your femoral nerve and your sciatic nerve

• Branches of these nerves supply movement and feeling to your ankle and foot

• A nerve block is an injection of local anaesthetic medicine around these nerves or their branches

• An ultrasound machine can be used to see your nerves and find the best place to inject. This will usually be near the back of your knee, in the middle of your thigh/groin and/or around your ankle

• The injection(s) can be performed awake, sedated or under general anaesthesia. One of the injections may be performed with you lying on your front

• The local anaesthetic ‘blocks’ information travelling along these nerves

• Your ankle or foot will become numb over the next 30 minutes

• A nerve block can be combined with sedation or a general anaesthetic, or you may remain awake

• If you opt for the procedure to be performed with a nerve block with no sedation or general anaesthesia, you may bring an electronic device to listen to music, read a book, watch a film, etc.

• Numbness gradually wears off over 24-48 hours and may last 2-3 days with “tingling” indicating return of nerve function

• Advantages: A nerve block should give pain relief for some hours, and reduces the need for strong pain relief medicines (which have side effects such as nausea and vomiting, itching, confusion, and constipation). This will help with a quicker return to eating and drinking 5

• Possible complications: These include infection, failure or incomplete numbness, and reduced mobility after your operation.

• A numb patch lasting for weeks is not uncommon. Permanent nerve damage is rare and although difficult to measure precisely, studies estimate that it happens in one in every 5,000 blocks. During general anaesthesia, nerve problems occur during one in every 2,500 cases.

• A small dose of local anaesthetic is placed around the nerves in your lower back. This is done by an injection in your lower back with you either sitting up or lying down on the side. This procedure is done before you have surgery.
• This causes a feeling of numbness from the waist down and blocks pain pathways for the duration of surgery and a few hours afterwards.
• Advantages: You are likely to have less sickness and drowsiness after the operation, and a few hours afterwards. You will usually eat and drink sooner. You remain in full control of your breathing. You breathe better in the first few hours after the operation. It may also help avoid blood clots in your legs and lungs
• Possible complications: These include failure, headache, low blood pressure, itching, and very rarely a blood clot in your back or infection
• A spinal anaesthetic can be combined with sedation or a general anaesthetic, or you may remain awake.

• Nerve blocks / spinal anaesthesia allow you to avoid having a general anaesthetic
• If you do not wish to be fully awake for your operation your anaesthetist can give you sedation so that you will feel sleepy and relaxed during the surgery
• Sedation can either be light or deep, depending on your preferences.
• Light sedation means you are relaxed but awake. Deep sedation means you are more likely to be asleep and less likely to recall what happened during the operation. Not everyone is suitable for deep sedation
• Sedation can often be tailored to your preference
• People who have sedation often have some memories of being awake in theatre
• Some people prefer to avoid any sedation and are happy to remain fully conscious.

• A nerve block can be combined with sedation or a general anaesthetic

• The advantages are that you gain the benefits of the nerve block or the spinal anaesthetic, but you are unconscious during the operation

• The general anaesthetic may be ‘lighter’ in strength, which means the unpleasant after-effects of the general anaesthetic may be minimised.

• Will ultimately be decided by your anaesthetist after discussion with yourself

• Will vary depending on exactly what type of operation you are having done

• May also depend on your other medical problems or allergies to certain pain relieving medicine.

This information leaflet provides a brief overview of the anaesthetic options for foot and ankle surgery. In modern anaesthesia serious problems are uncommon. Risk cannot be removed completely, but use of modern equipment and medicine, together with on-going training, anaesthesia has been made much safer in recent years. For detailed and extensive information on all aspects of anaesthesia, including further advantages/disadvantages and detailed risks, please visit the Royal College of Anaesthetists.