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Spinal Anesthesia: A Safe and Effective Alternative to General Anesthesia for Infantile DDH Surgery
Alex L Gornitzky1, Ashlee E Holman1, Carter Hall2
1Department of Orthopaedics, University of Michigan, Ann Arbor, MI.
Insights
Spinal anesthesia (SA) offers a safe and effective alternative to general anesthesia (GA) for infant hip reductions in developmental dysplasia of the hip (DDH). This approach may enable earlier surgical intervention, potentially improving outcomes and reducing the need for further procedures.
Area of Science:
- Pediatric Orthopedics
- Anesthesiology
Background:
- General anesthesia (GA) poses risks for infants under 1 year undergoing operative hip reduction for developmental dysplasia of the hip (DDH).
- Delaying surgery to avoid GA risks can reduce closed reduction success rates and compromise bone remodeling.
- This study evaluates spinal anesthesia (SA) as a safer alternative for infant hip reduction.
Purpose of the Study:
- To assess the safety and efficacy of spinal anesthesia (SA) for operative hip reductions in infants with DDH.
- To explore SA as a potential alternative to GA, mitigating associated risks in young children.
Main Methods:
- Multicenter, retrospective cohort study of infants (≤18 months) undergoing hip reduction for DDH.
- SA administered per institutional protocol for pediatric urologic procedures.
- Retrospective chart review for demographic, anesthetic, and operative data.
Main Results:
- 23 procedures (16 index reductions, 7 cast exchanges) performed under SA in infants aged 6.4 months on average.
- No surgical or anesthetic complications occurred; all hips remained reduced post-procedure.
- Most infants tolerated SA well, with 74% requiring supplemental IV sedation; none needed intubation.
Conclusions:
- Spinal anesthesia (SA) is a safe and effective anesthetic for infant hip reductions.
- SA may facilitate earlier surgical treatment for DDH, potentially enhancing acetabular remodeling.
- This technique could alter the management of infantile DDH, reducing GA risks and subsequent interventions.
Background:
Operative hip reductions for infantile DDH are traditionally performed under general anesthesia (GA). This introduces potential safety concerns, as risks related to GA are highest in children below 1 year. While surgery can be temporarily delayed to reduce these risks, this decreases the chances of a successful reduction via closed methods alone and also compromises valuable remodeling potential. This pilot study sought to evaluate the safety and efficacy of spinal anesthesia (SA) in infants undergoing operative hip reduction.
Methods:
This is a multicenter, retrospective cohort study of all infants 18 months or younger undergoing closed or open reductions for infantile DDH. SA was performed according to the institutional protocol previously developed for infants undergoing urologic procedures (>1200 procedures performed safely to date). A retrospective chart review was completed for demographic characteristics, treatment history, clinical exam, anesthetic course, and operative details.
Results:
A total of 16 index reductions were performed under SA, including 9 closed reductions and 7 open reductions (including 1 staged anterior open reduction). The mean age at first procedure was 6.4 months. Seven patients underwent a planned spica cast exchange under SA as well. In total, 23 procedures were performed under SA. The mean number of attempts at spinal was 1.4, and the mean SA setup time was 17 minutes. Following SA, most babies slept through the procedure without issue (including open reduction). Most babies (17/23, 74%) required additional IV sedation [13/17 (76% dexmedetomidine only)]. None required endotracheal intubation. There were no surgical or anesthetic complications. All treated hips remained concentrically reduced at the time of spica cast removal.
Conclusions:
SA is a safe and effective anesthetic for infant hip reductions. This proof-of-concept pilot study highlights a technical advance with the potential to change how (and when) pediatric orthopaedists treat infantile DDH. In addition to eliminating the risks of GA, SA may allow earlier surgery, which could improve acetabular remodeling and decrease the need for subsequent pelvic osteotomy.
Level Of Evidence:
Level IV-case series.
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