Complex Nasal Reconstruction in a Wide-awake Ambulatory Setting: A Study of Efficacy and Perioperative Patient Experience

Abstract

Background: The use of local anesthesia in nasal surgery has gained popularity as a cost-effective and safe alternative. With the potential benefit of reconstruction without using general anesthesia, the goal of the study was to evaluate the patient-reported experience in addition to surgical outcomes and perioperative complications. Methods: A mixed-methods study was completed with retrospective chart review and patient-reported outcome questionnaire. The primary outcome measures were demographics, oncologic and surgical details, and postoperative complications. Secondary outcome measures were aesthetic outcomes and procedure tolerance, which were gathered from the FACE-Q questionnaire. Results: Of the 22 patients who met inclusion criteria, nine patients (41%) had forehead flaps performed and 13 patients (59%) had multilayer reconstruction with local flaps and cartilage grafts. The average number of surgeries performed, including revisions, was 2.3 ± 0.2. The overall complication rate for reconstructions and revisions was 20%, most of these were minor complications. The overall subjective rating of patient's appearance was excellent with an average score of 83.9 (± 17.3) out of 100. There was minimal appearance distress as a product of the surgery with an average score of 84.9 (±18.8). On a scale of one to five, patients reported an average of 4.3 for convenience, 3.8 for efficiency of setup and procedure, and 3.4 out of 5 for comfortability with having an operation performed on their face wide awake. Conclusion: Our study demonstrated that complex nasal reconstruction performed under local anesthetic in a minor procedure setting is a feasible and safe option with good patient-reported outcomes.

New Frontiers in Wide-Awake Surgery

“…Below-knee leg amputation 53 200 mL 50 mL of 1% lidocaine with 1:100,000 epinephrine plus 150 mL of saline (0.25% lidocaine with 1:400,000 epinephrine) Forearm amputation 54 100 mL 50 mL of 1% lidocaine with 1:100,000 epinephrine plus 50 mL of saline (0.5% lidocaine with 1:200,000 epinephrine) Cancer mastectomy and lymph node dissection 55,56 500-750 mL 50 mL of 1% lidocaine with 1:100,000 epinephrine plus 700 mL of saline plus 10 mL of 0.5% bupivacaine with 1:200,000 epinephrine Bilateral breast augmentation 57,58 500-750 mL per side 50 mL of 1% lidocaine with 1:100,000 epinephrine plus 1450 mL of saline plus 10 mL of 0.5% bupivacaine with 1:200,000 epinephrine Forehead flap nasal reconstruction 59,60 30 mL in the forehead; 10 mL in the nose 1% lidocaine with 1:100,000 epinephrine Rhytidectomy with neck lift 300 mL total: 100 mL per face lift side and 100 mL for the neck 50 mL of 1% lidocaine with 1:100,000 epinephrine plus 250 mL of saline plus 10 mL of 0.5% bupivacaine with 1:200,000 epinephrine Bilateral upper lid blepharoplasty 61 5 mL per side 9 mL 1% lidocaine with 1:100,000 epinephrine plus 1 mL of 0.5% bupivacaine with 1:200,000 epinephrine Open mesh umbilical hernia repair 62,63 25 mL 25 mL 1% lidocaine with 1:200,000 epinephrine Inguinal hernia repair 46,64 120 mL 20 mL 1% lidocaine with 1:100,000 epinephrine plus 200 mL saline Knee arthroscopy 28 40 mL 20 mL of 0.5 % bupivacaine with adrenaline plus 20 mL of 1% lignocaine with adrenaline: 10 mL subcutaneously around each medial and lateral portal and 20 mL into the knee joint Clavicle fracture plate and screw fixation 100 mL 50 mL of 1% lidocaine with 1:100,000 epinephrine plus 50 mL of saline Radius plus ulna fracture plate and screw fixation 65 150 mL 50 mL of 1% lidocaine with 1:100,000 epinephrine plus 100 mL of saline Cubital tunnel release or ulnar nerve trasposition 66 60 mL 0.5 % lidocaine with 1:200,000 epinephrine Cubital tunnel plus carpal tunnel releases at the same time 67 80 mL 0.5 % lidocaine with 1:200,000 epinephrine Olecranon or radial neck fracture fixation 68 100 mL each or 150 mL for both 50 mL of 1% lidocaine with 1:100,000 epinephrine plus 150 mL of saline Triple forearm tendon transfer for radial nerve palsy 69 200 mL 50 mL of 1% lidocaine with 1:100,000 epinephrine plus 150 mL of saline field sterility.] Most newborns fall asleep at the end of feeding, the best form of general anesthesia.…”