SLR - March 2010 - Albemar Espiritu
Reference:
Parada, S., Baird, G., Auffant, R.A., Tompkins, B., Caskey, P. (2009). Safety of Percutaneous Tendoachilles Tenotomy Performed Under General Anesthesia on Infants With Idiopathic Clubfoot. Journal of Pediatric Orthopaedics. 29(8), 916-919.
Scientific Literature Reviews
Reviewed by: Albemar Espiritu, DPM
Residency Program: Cedars-Sinai Medical Center
Podiatric Relevance:
This retrospective study provides information on the safety of percutaneous tendoachilles tenotomy performed in the operating room under general anesthesia in patients with idiopathic clubfoot less than 1 year of age.
Methods:
This single institution study performed a respective review of idiopathic clubfoot patients less than 1 year of age who underwent percutaneous tendoachilles tenotomy under general anesthesia from 2000 to 2008. The anesthesia protocol provided all patients with general anesthesia using sevoflurane, weight-based acetominophen suppository dose, and local anesthetic consisting of 1mL of bupivacaine HCL mixed with 1:200,000 epinephrine. The admission criteria identified patients who were postconception age (PCA) less than 44 weeks or gestational age (GA) less than 37 weeks in which a hour postoperative period was required prior to discharge. Additionally, patients with a history of apneic event, ASA class III, or history of maternal drug use were admitted for overnight postoperative observation.
Results:
This study found 137 patients who underwent a total of 182 tenotomies under general anesthesia. Ninety-two tenotomies were unilateral, 45 were bilateral. The average postconception age (PCA) at time of surgery was 53.9 weeks (range, 41 to 90 wk, SD 9.8 wk). The patient population included 89 patients (65%) were under 3 months of age,
31 (23%) were between 4-6 months, 13 (9%) were between 7- 9 months, and 4 (3%) were between 10-12 months. Twenty-one patients (15.3%) were monitored postoperatively for apnea because of PCA under 44 weeks or gestational age under 37 weeks. Three patients (2.2%) were admitted overnight because of a maternal history of drug abuse. No patient showed apnea, bradycardia, or anesthesia-related complications No patients were American Society of Anesthesiologists Class III for comorbidities.
Conclusions:
Percutaneous tendoachilles tenotomy under general anesthesia is a safe procedure in infants with clubfeet. No complications were identified in this group. Almost all patients were discharged on the day of surgery.