Patients' experiences of awake surgery under local anaesthesia: A qualitative literature review

The growing adoption of local anaesthesia in surgical practice expands procedures that can be undertaken with patients fully awake. This shift introduces both opportunities and challenges for perioperative care, as patients remain conscious, and influenced by environmental, interpersonal and sensory factors.

To synthesise and interpret adult patients' experiences of undergoing surgery while awake under local anaesthesia.

A systematic qualitative literature review was conducted, drawing on peer-reviewed studies published between 2010 and 2025. An inductive analytic approach was applied. Nine studies were included.

Four overarching themes were identified: (1) the need for respectful, tailored communication; (2) the centrality of the perioperative team's presence and cohesion; (3) experiences of exposure, vulnerability and fluctuating control; and (4) strategies employed by patients to cope with intraoperative stressors. Across studies, continuous, person-centred communication and empathetic engagement reduced anxiety and enhanced perceived safety.

In awake surgery, interpersonal communication, team behaviours and the environmental context profoundly shape patients' intraoperative experiences. Person-centred communication, ethical attentiveness and a supportive perioperative presence are essential to fostering trust, reducing distress and enabling meaningful patient involvement. Theatre nurses and Operating Department Practitioners play a pivotal role in sustaining a safe, humane environment for awake patients.