Non-General Anesthesia for the Correction of Pediatric Trigger Thumbs

Tae Yeong Yang; Tae Kyung Lee; Jin Hee Choi; Sang Hyun Woo

doi:10.12790/ahm.2019.24.1.10

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Yang, Lee, Choi, and Woo: Non-General Anesthesia for the Correction of Pediatric Trigger Thumbs

Hand

Archives of Hand and Microsurgery 2019; 24(1): 10-16.

Published online: 28 February 2019

DOI: https://doi.org/10.12790/ahm.2019.24.1.10

Non-General Anesthesia for the Correction of Pediatric Trigger Thumbs

Tae Yeong Yang, Tae Kyung Lee, Jin Hee Choi, Sang Hyun Woo

W Institute for Hand and Reconstructive Microsurgery, W General Hospital, Daegu, Korea.

Corresponding author: Sang Hyun Woo. W Institute for Hand and Reconstructive Microsurgery, W General Hospital, 1632 Dalgubeol-daero, Dalseo-gu, Daegu 42642, Korea. TEL: +82-53-550-5000, FAX: +82-53-552-4000, handwoo@hotmail.com

Received 19 October 2018 Revised 26 December 2018 Accepted 26 December 2018

Korean Society for Surgery of the Hand, Korean Society for Microsurgery, and Korean Society for Surgery of the Peripheral Nerve

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report the outcome of non-general anesthesia methods for correction of 185 pediatric trigger thumbs.

Methods

The corresponding author performed a total of 185 cases of pediatric trigger thumbs over the last 5 years with either cell-phone assisted local anesthesia or local injection with IV sedation under oxygen mask. The methods of non-general anesthesia, age of operation and operation time, and perioperative complications of both operation and anesthesia were assessed.

Results

Mean operation age was 49.4 months. A total of 104 cases (56.2%) were operated under cell-phone assisted local anesthesia. In 72 cases (38.9%), the operations were performed under local injection with IV sedation. In 9 cases (4.9%), the anesthesia method was changed from cell-phone assisted local anesthesia to local injection with IV sedation due to noncooperation of the babies. Total operation time was 8 minutes and 49 seconds in cell-phone assisted local anesthesia and 7 minutes and 40 seconds in local injection with IV sedation. There were no intraoperative and postoperative complications related with either anesthesia or operation.

Conclusion

Cell-phone assisted local anesthesia and local injection with IV sedation anesthesia under oxygen mask is a very useful method for the operation of pediatric trigger thumbs. It lessens the burden of anesthesia and operation to babies and their parents as well as even operators.

Keywords: Pediatric trigger thumb, Non-general anesthesia

Figures and Tables

Fig. 1

Intraoperatively, the baby is watching the favorite video game or movies with cell phone or tablet personal computer.

Table 1

Demographic difference between groups of pediatric trigger thumb

Values are presented as number (%) or mean±standard deviation (range). The analysis was done with Student's t-test and chi-square test.

Table 2

Operation time of local injection with cell-phone assisted and intravenous sedative in unilateral pediatric trigger thumb

Values are presented as mean±standard deviation. The analysis was done with Student's t-test.

Table 3

Operation time of local injection with cell-phone assisted and intravenous sedative in bilateral pediatric trigger thumb

Values are presented as mean±standard deviation. The analysis was done with Mann-Whitney U-test.

Notes

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

References

1. Ger E, Kupcha P, Ger D. The management of trigger thumb in children. J Hand Surg Am. 1991; 16:944–947.

2. Moon WN, Suh SW, Kim IC. Trigger digits in children. J Hand Surg Br. 2001; 26:11–12.

3. Rodgers WB, Waters PM. Incidence of trigger digits in newborns. J Hand Surg Am. 1994; 19:364–368.

4. Jung HJ, Lee JS, Song KS, Yang JJ. Conservative treatment of pediatric trigger thumb: follow-up for over 4 years. J Hand Surg Eur Vol. 2012; 37:220–224.

5. Koh S, Horii E, Hattori T, Hiroishi M, Otsuka J. Pediatric trigger thumb with locked interphalangeal joint: can observation or splinting be a treatment option? J Pediatr Orthop. 2012; 32:724–726.

6. Lee ZL, Chang CH, Yang WY, Hung SS, Shih CH. Extension splint for trigger thumb in children. J Pediatr Orthop. 2006; 26:785–787.

7. Mulpruek P, Prichasuk S. Spontaneous recovery of trigger thumbs in children. J Hand Surg Br. 1998; 23:255–257.

8. Nemoto K, Nemoto T, Terada N, Amako M, Kawaguchi M. Splint therapy for trigger thumb and finger in children. J Hand Surg Br. 1996; 21:416–418.

9. Ogino T. Trigger thumb in children: current recommendations for treatment. J Hand Surg Am. 2008; 33:982–984.

10. Watanabe H, Hamada Y, Toshima T, Nagasawa K. Conservative treatment for trigger thumb in children. Arch Orthop Trauma Surg. 2001; 121:388–390.

11. Dunsmuir RA, Sherlock DA. The outcome of treatment of trigger thumb in children. J Bone Joint Surg Br. 2000; 82:736–738.

12. Giugale JM, Fowler JR. Trigger finger: adult and pediatric treatment strategies. Orthop Clin North Am. 2015; 46:561–569.

13. Marek DJ, Fitoussi F, Bohn DC, Van Heest AE. Surgical release of the pediatric trigger thumb. J Hand Surg Am. 2011; 36:647–652.e2.

14. Skov O, Bach A, Hammer A. Trigger thumbs in children: a follow-up study of 37 children below 15 years of age. J Hand Surg Br. 1990; 15:466–467.

15. Kozin SH. Deformities of the thumb. In : Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH, Cohen MS, editors. Green's operative hand surgery. 7th ed. Philadelphia: Elsevier;2017. p. 1320–1327.

16. Mauck BM. Congenital anomalies of the hand. In : Azar FM, Beaty JH, Canale ST, Campbell WC, editors. Campbell's operative orthopaedics. 13th ed. Philadelphia: Elsevier;2017. p. 3899–3900.

17. Strazar AR, Leynes PG, Lalonde DH. Minimizing the pain of local anesthesia injection. Plast Reconstr Surg. 2013; 132:675–684.

18. Debaene B, Plaud B, Dilly MP, Donati F. Residual paralysis in the PACU after a single intubating dose of nondepolarizing muscle relaxant with an intermediate duration of action. Anesthesiology. 2003; 98:1042–1048.

19. Koka BV, Jeon IS, Andre JM, MacKay I, Smith RM. Postintubation croup in children. Anesth Analg. 1977; 56:501–505.

20. Fiadjoe JE, Nishisaki A, Jagannathan N, et al. Airway management complications in children with difficult tracheal intubation from the Pediatric Difficult Intubation (PeDI) registry: a prospective cohort analysis. Lancet Respir Med. 2016; 4:37–48.

21. Lalonde DH. WALANT hand surgery in infants and children. In : Lalonde DH, editor. Wide awake hand surgery. Boca Raton, FL: CRC Press;2016. p. 65–67.

22. Dinham JM, Meggitt BF. Trigger thumbs in children. A review of the natural history and indications for treatment in 105 patients. J Bone Joint Surg Br. 1974; 56:153–155.

23. McAdams TR, Moneim MS, Omer GE Jr. Long-term follow-up of surgical release of the A(1) pulley in childhood trigger thumb. J Pediatr Orthop. 2002; 22:41–41.

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