Equipo Ponseti Dra. Anna Ey, Clínica Diagonal, 08950 Barcelona, Spain.
Hospital Sant Joan de Déu, 08950 Barcelona, Spain.
Int J Environ Res Public Health. 2022 Oct 25;19(21):13842. doi: 10.3390/ijerph192113842.
Percutaneous tenotomy of the Achilles tendon is part of the clubfoot management procedure known as the Ponseti method and is necessary for most infants requiring this treatment. However, the need to apply general anaesthesia or sedation during this procedure remains controversial. To our knowledge, no previous studies have been conducted to quantify infant distress, expressed as crying, when tenotomy is performed under local anaesthesia.
This clinical, prospective, cross-sectional, and observational study was composed of infants subjected to percutaneous Achilles tenotomy with local anaesthesia at an outpatient clinic. The degree of distress was measured using two smartphone apps (voice recorder and timer) in two iPhones, with each apparatus placed one meter from the baby. The following parameters were determined: procedure duration, crying duration, average crying intensity and maximum crying intensity. In addition, the following data were obtained: age, complications (if any) and the caregiver's satisfaction with the process.
Among the 85 infants submitted to percutaneous tenotomy, the mean age was 1.95 (+/-1.632) months (ranging from 0 to 7 months), the mean duration of the procedure was 8.134 (+/-5.97) seconds, (range 2.1 to 33.5 s), the infants' mean crying intensity was 88.99 dB and the maximum crying intensity was 96.56 dB. No vascular or anaesthetic-related complications were recorded. 96% of the caregivers were absolutely satisfied with the process.
Percutaneous Achilles tenotomy performed under local anaesthesia can safely be performed at the outpatient clinic. The procedure is fast and the crying time and intensity (mean values: 84 s and 89 dB, respectively) are minimal and tolerable. Knowledge of these parameters provides more accurate knowledge about the procedure. The caregivers consulted were absolutely satisfied with the tenotomy performed under local anaesthesia. In future studies, these parameters can be used for comparison with related surgical approaches.
经皮跟腱切断术是 Ponseti 方法治疗马蹄内翻足的一部分，是大多数需要这种治疗的婴儿所必需的。然而，在这个过程中是否需要应用全身麻醉或镇静仍然存在争议。据我们所知，以前没有研究过在局部麻醉下进行跟腱切断术时婴儿的痛苦程度（表现为哭泣）。
本临床、前瞻性、横断面和观察性研究由在门诊接受局部麻醉下经皮跟腱切断术的婴儿组成。使用两部 iPhone 上的两个智能手机应用程序（录音机和计时器）测量痛苦程度，每个仪器距离婴儿一米。确定了以下参数：手术持续时间、哭泣持续时间、平均哭泣强度和最大哭泣强度。此外，还获得了以下数据：年龄、并发症（如有）和照顾者对手术过程的满意度。
在 85 名接受经皮跟腱切断术的婴儿中，平均年龄为 1.95（+/-1.632）个月（0 至 7 个月），平均手术时间为 8.134（+/-5.97）秒（范围 2.1 至 33.5 秒），婴儿平均哭泣强度为 88.99 dB，最大哭泣强度为 96.56 dB。未记录到血管或麻醉相关并发症。96%的照顾者对手术过程完全满意。
在门诊进行局部麻醉下的经皮跟腱切断术可以安全进行。手术过程快速，哭泣时间和强度（平均值分别为 84 秒和 89 dB）极小且可耐受。了解这些参数可以更准确地了解手术过程。咨询的照顾者对局部麻醉下进行的跟腱切断术完全满意。在未来的研究中，可以将这些参数与相关的手术方法进行比较。
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