Are you awake for toenail removal?

Having toenail removal surgery while awake is an option some patients may consider. Being awake (rather than under general anesthesia) allows you to go home the same day. However, being awake means you will experience pain during the procedure. Whether you choose to be awake or asleep depends on your personal preferences and advice from your doctor.

Quick answers:

Can you be awake for toenail removal surgery?

Yes, it is possible to undergo toenail removal surgery while awake either with local anesthesia or no anesthesia at all.

What are the benefits of being awake?

Benefits include avoiding risks of general anesthesia, lower costs, quicker recovery time, and being able to return home the same day.

What kind of anesthesia options are there?

Options include: local anesthesia injection to numb the toe, sedation medication through IV to relax you, or no anesthesia at all.

How painful is it to be awake during the procedure?

Most patients report significant pain, especially with injection of local anesthesia. Pain levels depend on individual factors.

Can you drive yourself home afterwards?

Yes, you can drive yourself home after being awake for the procedure as long as you feel alert and are not impaired by sedation medication.

Deciding Between Being Awake vs Asleep for Toenail Removal

The first decision you and your doctor will make is whether you will be awake or asleep for the toenail removal procedure. There are pros and cons to each option.

Benefits of Being Awake

  • Avoid risks of general anesthesia – Being awake avoids the small but serious risks of general anesthesia including breathing problems, drug reactions, confusion or cognitive changes after surgery.
  • Lower costs – Local anesthesia is significantly cheaper than general anesthesia which requires an anesthesiologist.
  • Quick recovery – You will recover faster and be able to go home the same day.
  • Convenience – You can have someone drive you to and from the procedure.
  • Interact with your doctor – Being awake allows you to talk with your doctor during the procedure.

Benefits of Being Asleep

  • Avoid pain during procedure – You will be completely unaware and feel no pain during the procedure.
  • Less anxiety – You will not experience anxiety about watching the procedure.
  • Total numbness – General anesthesia provides complete numbness rather than the injection discomfort of local anesthesia.
  • Can’t move – No risk of reflexively moving your foot during the procedure.
  • No memory – Most patients have no memory of the procedure.

Your doctor can help weigh these factors and decide if being awake or asleep will be best for your individual health needs and preferences.

What Happens During Awake Toenail Removal?

If you opt to be awake for the toenail removal, here is a general overview of what you can expect:

  1. Anesthesia – You will be given either a local anesthetic injected into the toe to numb it, or no anesthesia at all. Sedation medication through an IV may also be used to help you relax.
  2. Positioning – You will sit or lie back with your foot elevated and cleaned.
  3. Tourniquet – A tourniquet band may be wrapped around your toe to restrict blood flow.
  4. Removal – Using surgical tools, your doctor will remove part or all of the affected toenail.
  5. Cauterization – Small blood vessels may be cauterized to stop bleeding.
  6. Bandaging – Your toe will be bandaged with gauze.
  7. Recovery – You will move to a recovery area for a short period before going home.

The procedure typically takes 20-30 minutes depending on how much of the nail is removed. Your doctor will talk you through each step so you know what to expect.

Anesthesia Options for Awake Toenail Removal

If you decide to have the toenail removal while awake, there are different options for anesthesia to reduce pain:

Local Anesthesia

This involves injecting lidocaine or a similar numbing medication directly into the toe around the base of the toenail. This numbs the area but you will be awake for the procedure.

Regional Block

A regional nerve block injects anesthesia to the nerves running to the toes. This provides extensive numbness but does not affect the rest of the leg. You remain awake.

Intravenous Sedation

Medication like midazolam or propofol can be given through an IV. This provides relaxation and some pain relief but you will not be fully asleep.

No Anesthesia

Some doctors may perform the toenail removal with no anesthesia at all. This obviously provides no pain relief.

Talk to your doctor about which option may be recommended for you.

What Does it Feel Like to be Awake During the Procedure?

Most patients report feeling significant pain and discomfort during an awake toenail removal procedure despite local anesthesia.

Injecting the local anesthetic is often described as a very painful bee sting sensation. After this, the toe should become numb although sensation may still remain.

During the nail removal itself, you may feel:

  • Pressure and tugging
  • Vibration from tools
  • Pain if anesthesia wears off
  • Occasional sharp pains or pinching
  • Discomfort watching the procedure

Having a conversation with the doctor or listening to music can help distract from the discomfort. Focus on taking slow deep breaths.

Those with a low pain tolerance or dental phobia may find being awake very difficult. Others are able to tolerate it well with relaxation techniques.

Factors Affecting Pain Levels When Awake

Several factors contribute to how much pain is felt when awake for toenail removal:

  • Effectiveness of local anesthetic – A poorly placed injection may not fully numb the area.
  • Extent of procedure – Removing the entire nail is more painful than partial removal.
  • Ingrown severity – Severe ingrown nails cause more baseline pain.
  • Medications/sedation – Sedatives help relaxation and pain relief.
  • Anxiety level – Those with high anxiety may perceive more pain.
  • Pain tolerance – Each person has a different pain tolerance.

It’s impossible to predict exactly how much it will hurt for each individual. Communicate with your doctor so they can maximize your comfort during the procedure.

Recovering After Awake Toenail Removal

One benefit of being awake for the toenail removal is that recovery time is much faster. Here is what to expect:

Returning Home

Most people can go home within 30 minutes of finishing the procedure since no general anesthesia was used. Ensure you have someone available to drive you home.


You can return to eating and drinking normally right away.


Over-the-counter medications like acetaminophen or ibuprofen can be used for residual pain. Narcotic pain medication is not typically prescribed.

Activity Level

Rest is encouraged after surgery but you can resume normal activity as tolerated. Avoid soaking the feet or tight shoes initially.

Bandage Care

Keep initial bandages dry and clean until your follow-up appointment. Soaking may be recommended thereafter.

Full recovery takes 2-4 weeks for the nail and skin to completely heal. Most people are able to return to work within 1-2 days.

Can you Drive Yourself Home After Being Awake?

Yes, most people are fine to drive themselves home after an awake toenail removal as long as:

  • You did not receive any sedation medication through an IV that causes lingering drowsiness or impaired reflexes.
  • You feel relatively pain-free, alert, and are able to press the pedals.
  • You are able to wear a shoe on the operative foot – it should not touch the pedals.
  • You have someone else available to drive just in case.

Talk to your doctor at your pre-op visit about specific recommendations for your individual situation.


Overall, being awake for toenail removal has some advantages including avoiding general anesthesia risks and enabling quicker recovery. However, the procedure can be quite painful despite local anesthetic numbing. Careful discussion with your doctor will allow you to make the best choice regarding awake versus asleep for your upcoming toenail surgery.

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