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Effects of Eating on Anxiety, Pain, and Satisfaction in Wide Awake Local Anesthesia No Tourniquet (WALANT) Hand Surgery Patients: A Pilot Randomized Study
Michael W Madsen, BA, Mikhail Pakvasa, MD, Pirooz Fereydouni, BA, Arthur Cowman, BS, Gregory Rafijah, MD; Jesse Kaplan, MD
University of California, Irvine School of Medicine, Irvine, CA
Background:
Standard preoperative guidelines advise patients to fast six to eight hours before surgery to reduce the risk of aspiration during general anesthesia. However, Wide-Awake Local Anesthesia No Tourniquet (WALANT) hand surgeries involve no sedation or airway manipulation, making fasting potentially unnecessary. Despite this, fasting protocols are often still applied. This study aims to compare outcomes between fasting and non-fasting WALANT patients undergoing hand surgery. We hypothesize that patients encouraged to eat a meal before their procedure will experience similar surgical outcomes but improved satisfaction and reduced perioperative anxiety due to greater comfort.
Methods:
In this randomized controlled study, patients were assigned to either a fasting or non-fasting group prior to their WALANT surgeries. Patients in the fasting group were instructed to not eat or drink anything six to eight hours before surgery, while patients in the non-fasting group were encouraged to have a light breakfast. Anxiety was measured preoperatively and postoperatively using the Amsterdam Preoperative Anxiety and Information Scale. Hunger, thirst, pain, and nausea were assessed using numeric scales. Interim data from 21 patients were analyzed using descriptive statistics, Mann-Whitney U-tests, and t-tests, with significance set at p<0.05.
Results:
Preliminary findings show that patients who fasted prior to WALANT surgeries trended toward higher preoperative and postoperative anxiety scores and lower overall surgical satisfaction. However, these differences were not statistically significant (p=0.560, p=0.471, and p=0.080, respectively) between the fasting and non-fasting groups. Fasting patients reported significantly greater hunger (p=0.004) and thirst (p=0.004) scores preoperatively as well as elevated hunger scores postoperatively (p=0.012) compared to non-fasting patients. These parameters remained elevated in fasting patients postoperatively, while non-fasting patients reported more stable scores. Preoperative pain scores were significantly higher in the fasting group (p=0.039), but postoperative differences were not significant (p=0.129). Minimal nausea was reported across both groups and phases, with no significant differences observed.
Conclusion:
Our results suggest fasting prior to WALANT hand surgeries may contribute to increased preoperative and postoperative anxiety and reduced patient satisfaction, although these trends did not reach statistical significance--likely due to the small sample size. Fasting was also associated with significantly greater hunger, thirst, and preoperative pain. These findings support the hypothesis that encouraging patients to eat before WALANT procedures may improve perioperative comfort without increasing surgical complications. While additional data are needed to validate these findings, early results indicate that modifying traditional fasting protocols could enhance the overall patient experience in WALANT settings.
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