Anesthesia for External Fixation Removal on a Leg
External fixation removal on a leg is typically performed without anesthesia at an outpatient facility, as this approach is well-tolerated by patients with high satisfaction rates.
Primary Anesthetic Approach
No anesthesia is the standard approach for external fixator removal in outpatient settings, with 85.7% of patients reporting satisfaction and 82.1% stating they would undergo the procedure again without anesthesia 1
The procedure causes moderate pain with an average peak intensity of 6.68 on a 10-point scale during removal, which decreases to 2.03 points within one week 1
Patients prefer outpatient removal without anesthesia primarily because it is faster (75% of patients) and avoids hospitalization (25% of patients) 1
Pain Characteristics During Removal
Schanz pin removal causes the most intense pain (reported by 60.7% of patients), particularly at the extremities of the limbs (75% of patients) 1
Pre-procedure pain averages 3.61 points, with the least intense pain during removal averaging 2.25 points and an average pain variation of 4.43 points 1
Patients' recollection of pain after the procedure (mean 5.29) is lower than the pain reported immediately after removal (mean 6.68), suggesting the discomfort is tolerable and quickly forgotten 1
When Anesthesia May Be Considered
Local Anesthesia Option
Local anesthesia can be used for patients who are particularly anxious or have low pain tolerance, though this is not routinely necessary 2
When local anesthesia is used, adhere to maximum safe doses: lidocaine with epinephrine 7 mg/kg, ropivacaine/levobupivacaine 3 mg/kg 3
Regional or General Anesthesia (Rarely Indicated)
Avoid dense, long-duration neuraxial or peripheral nerve blocks that significantly exceed the procedure duration, as these are unnecessary for simple hardware removal 4
General anesthesia is rarely indicated but may be considered if the patient requires complete immobility for complex removal scenarios or if the procedure is combined with other surgical components 3
Regional anesthesia (peripheral nerve blocks) is designed for open surgical procedures and carries unnecessary risks for simple external fixator removal 3
Clinical Context and Patient Population
Most patients undergoing external fixator removal are middle-aged men (89.3% using circular external fixators), with the leg being the most commonly involved limb segment 1
The majority (71.4%) have never used an external fixator before, making patient education about the removal process important 1
Critical Safety Considerations
Ensure adequate postoperative monitoring even when no anesthesia is used, as patients should be observed for any complications 1
Resuscitation equipment should be immediately available even for procedures performed without anesthesia, as complications can occur 3
For patients with high anesthetic risk or significant comorbidities, the no-anesthesia approach is particularly advantageous as it avoids anesthesia-related complications entirely 5, 2
Common Pitfalls to Avoid
Do not routinely offer general or regional anesthesia for straightforward external fixator removal, as this adds unnecessary risk and cost without significant benefit for most patients 1
Do not underestimate patient tolerance—the procedure is brief and pain is transient, with most patients finding it acceptable without anesthesia 1
Avoid performing the procedure in an operating room setting when outpatient removal is feasible, as this increases costs and delays without improving outcomes 1