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 Hajipoor

doi:10.18502/aacc.v10i3.15686

Javad Talebnejhad Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Maryam Mirzaei Moghaddam Department of Radiation Oncology, Tehran Azad University of Medical Sciences, Tehran, Iran.
Fateme Morsali Department of Anesthesiology, Iran University of Medical Sciences, Tehran, Iran.
Mojdeh Sarzaeim School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Behnam Panjavi Department of Orthopaedic and Trauma Surgery, Children's Medical Centre, Tehran University of Medical Sciences, Tehran, Iran.
Taghi Baghdadi Department of Orthopedic Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Mehrdad Goudarzi Department of Anesthesiology, Children’s Hospital Medical Centre, Tehran University of Medical Sciences, Tehran, Iran.
Amir Hossain Khairollahi Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Zahra Vahdati School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Hossein Nematian School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Asghar Hajipoor Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.

DOI: https://doi.org/10.18502/aacc.v10i3.15686

Keywords: Pain management; Pediatric anesthesia; Clubfoot; Posneti; Sevoflurane; General anesthesia

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.