Extended Emergence Strategy on Post-Anesthesia Care Unit Events After Outpatient Orthopedic Surgery

Extended Emergence Trajectory on Post-Anesthesia Care Units Events in Ambulatory Lower-Extremity Orthopedic Surgery: A Randomized Controlled Trial

The goal of this clinical trial is to learn if an extended emergence from anesthesia can improve recovery room (Post-Anesthesia Care Unit or PACU) outcomes in lower-leg or foot surgery with nerve blocks. The primary questions it aims to answer are:

• Does a longer wake-up help participants think more clearly soon after surgery compared with usual approaches?
• Does it lower pain scores, lower the amount of pain medications used, and shorten the time it takes to go home from recovery room?

Researchers will compare 2 groups of adults who are having similar lower-extremity orthopaedic surgeries with regional and propofol anesthesia.

Inclusion Criteria:

• Participants with American Society of Anesthesiologists (ASA) physical status I-III
• Scheduled for Elective Foot/Ankle Orthopaedic surgery at Stanford Health under planned propofol-based intravenous anesthesia and regional nerve block for preoperative analgesia
• Able and willing to complete all cognitive assessments and Brice Interview in PACU

Exclusion Criteria:

• ASA physical status IV or V
• Chronic opioid therapy
• Chronic benzodiazepine use or ongoing treatment with strongly anticholinergic medications within 30 days prior to surgery.
• Known major neuro-cognitive disorder, active psychotic disorder, or other severe psychiatric condition that, in the opinion of the investigator, would interfere with valid cognitive testing.
• Active cardiac or neurological stimulators or pumps in use
• Severe uncorrected visual or hearing impairment that precludes valid cognitive battery or interview completion.
• Inability to speak and understand the study language sufficiently to provide informed consent and complete study assessments.
• Inability to provide informed consent or lack of a legally authorized representative when required.
• Concurrent participation in another interventional study that could confound PACU cognitive or delirium outcomes.