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Postanesthesia alternation of lower limb contractures in children with spastic cerebral palsy

Lai, Yu-Chenga,,b; Lin, Huey-Shyand; Pan, Hui-Fena; Chang, Wei-Ninga,,h; Hsu, Chien-Jena,,d,,e; Renn, Jenn-Hueia; Kuo, Tsu-Jenc,,f,,g

Journal of Pediatric Orthopaedics B: January 2020 - Volume 29 - Issue 1 - p 9–14
doi: 10.1097/BPB.0000000000000565
Cerebral Palsy
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The aim of this study was to clarify the effects of general anesthesia (GA) on joint range of motion (ROM) in children with spastic cerebral palsy (SCP). Eighty-four SCP cases (mean age 8.4 years) admitted for first corrective surgery were retrospectively reviewed. Lower limb ROM were measured 1 day before operation and immediately after GA. Contracture of hip, knee, and ankle joints decreased significantly after GA, with + 11.1° (39.5%) for the hip abduction angle, −3.7° (18.0%) for the Thomas test, −15.0° (19.1%) for the popliteal angle, + 6.6° (39.8%) and 7.0° (109%) for ankle dorsiflexion with knee flexion and extension, respectively (all P <0.001). These changes were correlated positively to pre-GA contracture and body weight, negatively to age, but independent of preoperative functional level, geographic classification of SCP, or modified Ashworth scale. On the basis of these findings, routine post-GA reassessments of joint ROM before corrective surgeries were recommended for pediatric SCP cases.

aDepartment of Orthopaedics, Kaohsiung Veterans General Hospital

bDepartment of Occupational Therapy

cDepartment of Dental Technology, Shu-Zen Junior College of Medicine and Management

dSchool of Nursing, Fooyin University

eDepartment of Medical Education and Research, Kaohsiung Veterans General Hospital

fDepartment of Dentistry, Kaohsiung Veterans General Hospital

gDepartment of Marine Biotechnology and Resources, National Sun Yat-sen University, Kaohsiung

hSchool of Medicine, National Yang-Ming University, Taipei, Taiwan

Correspondence to Wei-Ning Chang, MD, Department of Orthopaedics, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung 813, Taiwan, Tel: + 886 7342 2121 3051; fax: + 886 7342 2121 3069;, e-mail: wnchang@vghks.gov.tw

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