Early Forays Into Using Spinal Anesthesia for Inguinal Hernia Surgery in Preterm Infants: A Retrospective Analysis From a Single Center in Karnataka.

Abstract

Neonates, particularly those born preterm, have a higher incidence of inguinal hernia and are at increased risk of cardiopulmonary complications associated with general anesthesia. To mitigate these risks, spinal anesthesia has been adopted in our institution for over two decades as the preferred technique for inguinal hernia repair in neonates. This retrospective study presents a 6-year experience with neonatal spinal anesthesia and includes both term and preterm infants undergoing inguinal surgery. We specifically analyzed cases in which spinal anesthesia was used in neonates with a postconceptional age below 50 weeks. Nineteen patients underwent inguinal surgery under spinal anesthesia in this timeframe. The gestational age at birth ranged from 27 to 38 weeks. The postmenstrual age at the time of surgery ranged from 35 to 46 weeks. The birth weight ranged from 740 to 3300 g, whereas the weight at surgery ranged from 1550 to 4900 g. A 26G hypodermic needle was used to give the spinal block, and 0.2 mL/kg of 0.5% heavy bupivacaine was injected. No cases required respiratory support and/or inotropic support during the procedure and postoperatively. None had apnea during/after surgery, including the four cases of bronchopulmonary dysplasia. None required general anesthesia. Spinal anesthesia for inguinal hernia repair is a safe and efficient method that obviates the necessity for NICU admission or any escalation in respiratory care, including in the cases of bronchopulmonary dysplasia.