Inguinal hernia repair under spinal anesthesia is safe in newborns

Infographic · Sep 2021 · 1 min read

In brief

This 6-year study of 105 infants demonstrates that spinal anesthesia is a safe alternative to general anesthesia for inguinal hernia repair in neonates, with 91% success rate. SA appears most suitable for infants under 4000g, with conversion to GA correlating with prolonged operative time beyond 40 minutes.

Spinal anesthesia is safe and effective for inguinal hernia repair in newborns, avoiding general anesthesia exposure in early life.
SA success rate was 91%, with failure positively correlated to higher infant weight at surgery.
SA is most suitable for infants weighing <4000g; conversion to GA occurred when operative time exceeded ~44 minutes.
No differences in operative time or complication rates between SA and GA groups at 18-month follow-up.
SA offers a viable alternative to GA for routine neonatal inguinal hernia repair without compromising surgical outcomes.

Written by the GCMD Library team from the infographic.

The infographic uses a red, white, and gray color scheme with simple iconography. On the left, a stylized infant figure with circles highlighting the inguinal hernia location. The center and right sections use icons of infants and medication symbols to illustrate comparison points. Horizontal bars represent data comparisons between the two anesthesia approaches.

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.

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