Non-General Anesthesia Techniques for Pediatric Trigger Thumb Release: An Institutional Experience With Audiovisual Distraction- and Sedation-Assisted Local Anesthesia.

Abstract

Timely surgical correction of pediatric trigger thumb can be delayed due to the perceived risks of general anesthesia. This study introduces 2 non-general anesthesia protocols, sedation-assisted local anesthesia (SALA), and audiovisual distraction-assisted local anesthesia (ADALA) for pediatric trigger thumb release. Between January 2015 and December 2024, a total of 296 trigger thumb releases were performed in 249 children under 12 years of age. The choice between SALA and ADALA was based on each child's ability to cooperate at the time of surgery. Sedation was achieved through intravenous administration of ketamine in the SALA group. In the ADALA group, audiovisual distraction was provided using a caregiver-provided smartphone, with the child watching content during the procedure. In both groups, caregivers were allowed to remain at the bedside throughout the surgery. Patient demographics, perioperative outcomes, postoperative complications, and caregiver-reported satisfaction were assessed. The mean age at surgery for the total cohort was 49.11 months. Children in the SALA group were significantly younger at both the time of symptom recognition and the time of surgery. Tourniquet duration was longer in the ADALA group than in the SALA group (unilateral cases, 9.92 ± 1.88 vs 8.70 ± 2.01 minutes; <i>P</i> < .001). Both groups demonstrated high caregiver satisfaction and comparable willingness to repeat the same anesthesia method. No respiratory complications or tourniquet-related discomfort were reported in either group. Sedation-assisted local anesthesia (SALA) and ADALA were feasible and well-tolerated in children undergoing trigger thumb release. By avoiding general anesthesia, these techniques may offer families a treatment option that reduces anesthesia-related hesitation and the delays it can cause.