Factors Impacting Outcomes of Peripheral Nerve Blockade in Children With Charcot–Marie–Tooth Disease Undergoing Foot Surgery

BACKGROUND: Charcot-Marie-Tooth (CMT) disease is the most common inherited peripheral neuropathy in children and frequently causes progressive foot deformities requiring surgical correction. Peripheral nerve blockade (PNB) is central to multimodal perioperative analgesia, yet concerns persist that it may exacerbate pre-existing neuropathy through a "double crush" mechanism. Evidence on PNB safety in pediatric CMT remains limited. AIMS: This study evaluated neurologic outcomes and postoperative analgesia after PNB in children with CMT undergoing foot surgery. METHODS: As part of a quality-improvement initiative, we retrospectively reviewed all patients under 18 years of age with genetically confirmed CMT who underwent foot surgery with PNB between 2017 and 2023. The primary outcome was the presence of new or worsened postoperative neurologic deficits potentially attributable to PNB. Secondary outcomes included postoperative pain scores, opioid use within 72 h, and prolonged block duration. PNB-related variables were analyzed descriptively, with exploratory genotype comparisons. RESULTS: Fifteen children underwent 22 operative sessions involving 24 limbs, corresponding to 34 foot procedures and 56 PNBs. Seventy-one percent of foot procedures were performed as part of bilateral simultaneous surgery, and 53% included combined soft-tissue and bony correction. Median age was 12 years (IQR 10.5-12.5), and 67% were female. A popliteal/sciatic block was performed in all procedures, often combined with saphenous (50%) or adductor canal (15%) blocks. Pain scores were generally low and decreased over the first 72 postoperative hours, with low-dose opioid use documented in 11/22 operative sessions (50%). Two limbs (8%) developed transient postoperative neurologic deficits, and seven limbs (29%) had prolonged block duration. In exploratory patient-level analyses, both outcomes occurred more frequently among patients with CMT1F (p = 0.057 and p = 0.0037, respectively), who comprised four patients (27% of the cohort). CONCLUSIONS: In this pediatric CMT cohort, no permanent neurologic complications potentially attributable to PNB were observed. Pain scores were generally low in the context of multimodal analgesia, although low-dose opioids were required in about half of cases. The increased frequency of prolonged block in patients with CMT1F should be interpreted cautiously given the small subgroup size and may warrant prospective genotype-stratified investigation.