FEASIBILITY, SAFETY AND OUTCOME OF INGUINAL HERNIA REPAIR UNDER SPINAL VERSUS GENERAL ANESTHESIA IN PRETERM AND TERM INFANTS
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In brief
In brief
Comparative study of 105 infants undergoing inguinal hernia repair shows spinal anesthesia is safe and effective, with 9% failure rate correlating to higher weight. Spinal anesthesia is particularly suitable for infants under 4kg, with conversion to general anesthesia primarily due to prolonged operative time exceeding 40 minutes.
Written by the GCMD Library team from the article.
Abstract
Background
Inguinal hernia repair (IHR) is a common operation in preterm and term infants. Recently, spinal anesthesia (SA) has been proposed as an alternative to avoid exposure to general anesthesia (GA) during early life. The aim of this study was to compare surgical outcomes of open IHR performed under SA versus GA in neonates and infants, and to detect criteria to predict the success or failure of SA.
Materials and methods
This is a 6-year, single center, nonrandomized interventional study (2013–2019). SA was performed with 0.5% bupivacaine. GA was given using propofol, fentanyl, sevoflurane, and laryngeal mask. Patient demographics, operative time, intraoperative events related to surgery or anesthesia, and complications were analyzed at short and long-term follow-up.
Results
68 infants (78 IHR) and 37 infants (44 IHR) received SA and GA at the discretion of the anesthesiologist, respectively. SA failure rate was 9%, and positively correlated with weight at surgery (p = 0.001; rp = 0.38). Conversion from SA to GA occurred in 4 (6%) patients owing to prolonged operative time (43.75 ± 4.8 vs 23.02 ± 11.3 min; p = 0.0006). There were no differences regarding operative time and intra- and postoperative complications among the two groups at mean follow-up of 18.53 ± 21.9 months.
Conclusions
This pilot study confirms that SA is safe, effective and not detrimental to surgical outcome of neonates and infants undergoing IHR. Additionally, it may help further define what patients may have a successful SA. Our experience suggests that SA is especially suitable in infants weighing <4000 g, and conversion to GA correlates with prolonged operative time.
Level of evidence
Level II.