Quantification of Procedure Time and Infant Distress Produced (as Crying) When Percutaneous Achilles Tenotomy Is Performed under Topical Local Anaesthesia: A Preliminary Study

Abstract

Introduction: 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. Material and Methods: 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. Results: 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. Conclusions: 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.