Anesthesia for planned foot surgery
May 31, 2013 | 20,00 EUR | answered by Dr. med. Ralf Berg
Dear Sir or Madam,
10 years ago, I sprained my right foot. Although there was swelling, I had very little to no discomfort. And since I don't like going to the doctor very much, I didn't pay much attention to it. However, this year my foot started bothering me more and the pain became stronger. In the end, I decided to see a doctor. Eventually, an arteriovenous fistula was diagnosed on my right foot. This is now scheduled to be surgically treated on June 17th, as there seems to be no alternative. The surgeon already ruled out local anesthesia because they need to work on the foot calmly. Therefore, he said only general anesthesia or regional anesthesia are options. Since I would like to get a second opinion, I have the following question:
1. I absolutely don't want to be "put to sleep", so general anesthesia is not an option for me as I had bad experiences with it as a child. I have read that spinal anesthesia is often performed for foot surgeries. However, as a child, I was diagnosed with a crooked spine. I had to do physical therapy, which didn't help much. I have had no complaints related to it over the years. I have never sought treatment for it since then. Could there be any problems with spinal anesthesia in this context?
Thank you!
Dear questioner,
in general, a spinal anesthesia is possible for procedures on the foot. It is extremely rare not to find access to the spinal space. Firstly, it is possible to search for a passage between the vertebrae at different levels. Secondly, there is also the possibility to access the spinal canal from the side.
Although multiple punctures may be necessary, the pain is not strong because the injection site can be anesthetized, and the spinal needles that are advanced are very thin. Most people only perceive this as a dull pressure in the back.
Based on your description, I see no reason why a spinal anesthesia would not be feasible. In any case, you can discuss this with your anesthesiologist beforehand. They will examine your lumbar spine, feel for it, and then decide if it is not possible from the outset. Based on the available information, I find that very unlikely.
It is worth mentioning that a nerve block (3 in 1 block) may also be an option, but only if the procedure does not last too long. You should also discuss this possibility with your anesthesiologist. However, this is only possible if the vascular procedure does not last longer than 2 hours. Since your surgeon needs peace and time, spinal anesthesia is definitely the better solution.
Best regards, R. C. Berg
