Patients Tracking Pain Episodes Show Wide-awake Local Anesthesia Without Tourniquet Can Be Nearly Painless

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Abstract
Background: Minimally painful tumescent local anesthesia ensures patients feel only the first needle insertion, with no further pain. This technique includes real-time patient feedback, where they report each pain event during injection. Methods: This prospective study involved 154 consecutive patients undergoing wide-awake local anesthesia no tourniquet surgery at 3 hand surgery centers (January–April 2024). Patients objectively scored pain events during injection and rated pain intensity (0–10 Likert scale), intraoperative pain, anxiety, and overall experience. Results: During local anesthesia injection, 61 (40%) patients reported no pain, 92 (59.7%) reported 1 pain event, and 1 (0.7%) patient reported 2 events. Among the 93 patients who felt pain, 90 reported only mild discomfort (1–2 of 10), whereas 3 reported moderate pain (3–5 of 10). Anxiety levels during anesthesia and surgery were 3 of 10 or less for 147 (95.5%) patients. Conclusions: Real-time patient feedback improved surgeons’ ability to administer tumescent local anesthesia with minimal pain. As a result, most patients experienced no pain or only 1 minor event during local anesthesia injection for wide-awake local anesthesia no tourniquet surgery.

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