Spinal Anesthesia: A Safe and Effective Alternative to General Anesthesia for Infantile DDH Surgery.

Abstract

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. 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. 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. 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 IV-case series.