The Efficacy of General Anesthesia with Sevoflurane for Pain Management in Neonates and Infants with Idiopathic Clubfoot Treated with Ponseti Technique and Percutaneous Achilles Tenotomy
-
Javad Talebnejhad
,
Maryam Mirzaei Moghaddam
,
Fateme Morsali
,
Mojdeh Sarzaeim
,
Behnam Panjavi
,
Taghi Baghdadi
,
Mehrdad Goudarzi
,
Amir Hossain Khairollahi
,
Zahra Vahdati
,
Hossein Nematian
,
Asghar Hajipour
Abstract
Background: Idiopathic clubfoot deformity is a relatively common congenital pediatric foot deformity. A percutaneous Achilles tenotomy (PAT) is required to correct the equinus deformity as it is the most resistant component of clubfoot deformity. Although this procedure is mainly performed with local anesthesia, performing this procedure with general anesthesia has significant advantages. Aims: The purpose of this study was to compare the safety and efficacy of post-procedural pain management of PAT in the treatment of clubfoot with the Ponseti method when performed in a clinic setting with local anesthetic or under general anesthesia
Methods: This is a multicentric prospective observational evaluation on children less than one year of age with idiopathic clubfoot whom referred for Ponseti casting and PAT. This procedure was done in the control group with local anesthesia and in the intervention group with Sevoflurane mask 8% (MAC 2) and maintenance of anesthesia with Sevoflurane mask 4% (N2O/O2, 50%). The neonatal infant pain scale (NIPS), the amount of milk, and mood changes were evaluated as a criterion to measure the pain level.
Results: NIPS score in the intervention group was significantly lower than the control group. Children in the intervention group consume significantly more milk than the control group. Furthermore, 76% of children in the intervention group were classified as "calm," 24% as "relatively restless," and no child was classified as "severely restless." While in the control group, 54% of children were classified as "severely restless," and the remaining 46% as "relatively restless."
Conclusion: Our result showed that using general anesthesia to perform achillotomy in the treatment of clubfoot in children could be associated with less pain in these patients and without significant complications.
[2] Dobbs MB, Nunley R, Schoenecker PL. Long-term follow-up of patients with clubfeet treated with extensive soft-tissue release. J Bone Joint Surg Am. 2006; 88(5):986-96.
[3] Maranho D, Volpon J. Congenital Clubfoot. Acta Ortopédica Brasileira. 2009; 19:163-7.
[4] Ponseti IV. Treatment of congenital club foot. J Bone Joint Surg Am. 1992; 74(3):448-54.
[5] Cooper DM, Dietz FR. Treatment of idiopathic clubfoot. A thirty-year follow-up note. J Bone Joint Surg Am. 1995; 77(10):1477-89.
[6] Laaveg SJ, Ponseti IV. Long-term results of treatment of congenital club foot. J Bone Joint Surg Am. 1980; 62(1):23-31.
[7] Herzenberg JE, Radler C, Bor N. Ponseti versus traditional methods of casting for idiopathic clubfoot. J Pediatr Orthop. 2002; 22(4):517-21.
[8] Scher DM, Feldman DS, van Bosse HJ, Sala DA, Lehman WB. Predicting the need for tenotomy in the Ponseti method for correction of clubfeet. J Pediatr Orthop. 2004; 24(4):349-52.
[9] Lebel E, Karasik M, Bernstein-Weyel M, Mishukov Y, Peyser A. Achilles tenotomy as an office procedure: safety and efficacy as part of the Ponseti serial casting protocol for clubfoot. J Pediatr Orthop. 2012; 32(4):412-5.
[10] Bor N, Katz Y, Vofsi O, Herzenberg JE, Zuckerberg AL. Sedation protocols for Ponseti clubfoot Achilles tenotomy. J Child Orthop. 2007; 1(6):333-5.
[11] Parada SA, Baird GO, Auffant RA, Tompkins BJ, Caskey PM. Safety of percutaneous tendoachilles tenotomy performed under general anesthesia on infants with idiopathic clubfoot. J Pediatr Orthop. 2009; 29(8):916-9.
[12] Dobbs MB, Gordon JE, Walton T, Schoenecker PL. Bleeding complications following percutaneous tendoachilles tenotomy in the treatment of clubfoot deformity. J Pediatr Orthop. 2004; 24(4):353-7.
[13] Changulani M, Garg N, Bruce CE. Neurovascular complications following percutaneous tendoachillis tenotomy for congenital idiopathic clubfoot. Arch Orthop Trauma Surg. 2007; 127(6):429-30.
[14] Chotigavanichaya C, Scaduto AA, Jadhav A, Otsuka NY. Accessory soleus muscle as a cause of resistance to correction in congenital club foot: a case report. Foot Ankle Int. 2000; 21(11):948-50.
[15] Allen GS, Cox CS, Jr., White N, Khalil S, Rabb M, Lally KP. Postoperative respiratory complications in ex-premature infants after inguinal herniorrhaphy. J Pediatr Surg. 1998; 33(7):1095-8.
[16] von Baeyer CL, Marche TA, Rocha EM, Salmon K. Children's memory for pain: overview and implications for practice. J Pain. 2004; 5(5):241-9.
[17] Weisman SJ, Bernstein B, Schechter NL. Consequences of inadequate analgesia during painful procedures in children. Arch Pediatr Adolesc Med. 1998; 152(2):147-9.
[18] Ponseti IV, SMOLEY EN. Congenital club foot: the results of treatment. JBJS. 1963; 45(2):261-344.
[19] Morray JP, Geiduschek JM, Ramamoorthy C, Haberkern CM, Hackel A, Caplan RA, et al. Anesthesia-related cardiac arrest in children: initial findings of the Pediatric Perioperative Cardiac Arrest (POCA) Registry. Anesthesiology. 2000; 93(1):6-14.
[20] Murat I, Constant I, Maud'huy H. Perioperative anaesthetic morbidity in children: a database of 24,165 anaesthetics over a 30-month period. Paediatr Anaesth. 2004; 14(2):158-66.
[21] Tuhanioğlu Ü, Oğur HU, Seyfettinoğlu F, Çiçek H, Tekbaş VT, Kapukaya A. Percutaneous achillotomy in the treatment of congenital clubfoot: should it be performed in the operating theater or the polyclinic? J Orthop Surg Res. 2018; 13(1):155.
| Files | ||
| Issue | Vol 10 No 3 (2024): Summer |
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| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/aacc.v10i3.15686 | |
| Keywords | ||
| Pain Management Pediatric Anesthesia Clubfoot Posneti Sevoflurane General Anesthesia | ||
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