Spinal Versus General Anesthesia With Popliteal and Adductor Canal Blocks for Ambulatory Foot and Ankle Surgery.

The purpose of this study is to determine if there is a difference in patient outcomes with
general anesthesia versus spinal anesthesia when given in addition to popliteal and adductor
canal nerve blocks for foot and ankle surgery. Popliteal and adductor canal nerve blocks are
injections of local anesthetic agents near nerves in the back and front of the knee going to
the foot and ankle that provide numbness during and after surgery. These peripheral nerve
blocks offer good pain control and reduce the need for opioids (opioids are pain medications
such as morphine, Dilaudid, and oxycodone). General anesthesia involves the flow of oxygen
and anesthesia gas through a tube which, along with additional intravenous medications,
causes unconsciousness and unawareness of sensations during surgery. Spinal anesthesia
involves an injection of local anesthetic in the lower back, which causes numbness below the
waist. In addition to spinal anesthesia, a sedative is typically given intravenously to cause
relaxation and sleepiness throughout surgery.

General, spinal, and nerve block anesthesia are all routinely used for surgery at the
Hospital for Special Surgery. General or spinal anesthesia is typically used in addition to
peripheral nerve blocks during foot and ankle surgery to 1) allow the surgeons to use a thigh
tourniquet to reduce bleeding, 2) provide anesthesia earlier, and 3) prevent unwanted
movement. However, it is unclear whether general or spinal anesthesia provides better patient
outcomes when given with peripheral nerve blocks. Some reports show that on its own, spinal
anesthesia has advantages over general anesthesia in terms of side effects such as nausea and
pain. However, these advantages may also be gained from combining peripheral nerve blocks
with general anesthesia. Spinal anesthesia can be associated with headache and backache,
although headache and backache can also happen after operations performed with general
anesthesia. A previous study at the Hospital for Special Surgery showed low rates of nausea
among patients who received nerve blocks with spinal anesthesia, and no nausea among patients
who received a nerve block with general anesthesia. Therefore, the primary aim of this study
is to determine if, as a treatment, either general or spinal anesthesia has advantages over
the other treatment in terms of readiness for discharge, side effects, pain and patient
satisfaction in an ambulatory foot and ankle population.