Local Anesthetic Injection Before Incision Decreases General Anesthesia Requirements in Pediatric Trigger Thumb...

Area of Science:

• Pediatric Anesthesiology
• Surgical Pain Management
• Neurodevelopmental Toxicology

Background:

• Animal studies suggest neurotoxicity from inhalational anesthesia.
• Clinical evidence on anesthesia-related neurodevelopmental changes in children is inconclusive.
• Reducing anesthetic exposure in pediatric surgery is a prudent measure.

Purpose of the Study:

• To determine if pre-incision local anesthetic injection reduces inhalational anesthetic exposure compared to post-release injection in pediatric trigger thumb release.
• To assess the impact of local anesthetic timing on postoperative pain and length of stay.

Main Methods:

• Single-center randomized controlled trial involving pediatric patients (≤4 years) undergoing unilateral trigger thumb release.
• Patients randomized to preincision or postrelease local anesthesia injection.
• Collected data on demographics, operative times, cumulative sevoflurane dose, and PACU recovery.

Main Results:

• A 21% reduction in cumulative sevoflurane dose was observed in the preincision group (23.2 vol%) compared to the postprocedure group (28.1 vol%) (P=0.03).
• No significant differences were found in age, sex, operative time, tourniquet time, postoperative pain, rescue pain medication use, nausea, or discharge time.
• 24 subjects were enrolled: 13 in the preincision group and 11 in the postprocedure group.

Conclusions:

• Preincision local anesthetic injection significantly decreases cumulative sevoflurane dose during trigger thumb release.
• This technique is a low-risk, simple method to reduce general anesthesia requirements.
• It may mitigate neurotoxicity risks associated with anesthetic exposure, especially in longer procedures.