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Spinal Anesthesia is Superior to General Anesthesia for Percutaneous Achilles Tenotomy in Infants

Michael A Acquaviva1, Christine B Caltoum2, Robert J Bielski2

  • 1Departments of Clinical Anesthesia.

Journal of Pediatric Orthopedics
|April 12, 2021
PubMed

Insights

Spinal anesthesia (SP) in infants undergoing percutaneous Achilles tenotomy (PAT) resulted in significantly less opioid use and faster recovery compared to general anesthesia (GA). This suggests SP is a safer alternative for pediatric procedures.

Area of Science:

  • Pediatric Anesthesiology
  • Regional Anesthesia Techniques
  • Neurodevelopmental Research

Background:

  • Growing concerns regarding the neurodevelopmental effects of inhaled halogenated anesthetics in infants.
  • Increasing interest in regional anesthesia as a safer alternative to general anesthesia for pediatric surgical procedures.
  • Infants undergoing percutaneous Achilles tenotomy (PAT) are suitable candidates for spinal anesthesia (SP).

Purpose of the Study:

  • To compare the efficacy and safety of spinal anesthesia (SP) versus general anesthesia (GA) for infants undergoing percutaneous Achilles tenotomy (PAT).
  • To evaluate perioperative outcomes, including opioid administration, recovery times, and anesthetic management, in infants undergoing PAT with SP compared to GA.

Main Methods:

  • A case-control study comparing 30 infants who underwent PAT with SP to 15 infants who underwent PAT with GA.
  • Data collected included perioperative times, vital signs (heart rate and blood pressure), and opioid administration.
  • Infants in the SP group had a mean age of 2.3 months, and those in the GA group had a mean age of 2.0 months.

Main Results:

  • Significantly fewer infants in the SP group received perioperative opioids (3.3%) compared to the GA group (67%) (P<0.0001).
  • Anesthesia start to surgery start time was shorter in the SP group (8.5 min vs. 14 min, P<0.0009).
  • First oral intake (12 min vs. 31 min, P<0.0033) and Phase 1 PACU recovery (15.5 min vs. 34 min, P<0.0026) were significantly faster in the SP group.

Conclusions:

  • Infants undergoing PAT with SP experienced reduced opioid requirements and avoided potent inhaled anesthetics.
  • SP facilitated faster and qualitatively better postoperative recovery, with no need for airway devices.
  • Spinal anesthesia presents a favorable alternative to general anesthesia for infants undergoing PAT, prioritizing neurodevelopmental safety and improved recovery.
Abstract

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