Spinal anesthesia for inguinal hernia repair in infants: a feasible and safe method even in emergency cases.

Abstract

BACKGROUND:

Inguinal hernia repair is the most frequently performed surgical procedure in infants and children. Especially in premature infants, prevalence reaches up to 30% in coincidence with high rates of incarceration during the first year of life. These infants carry an increased risk of complications due to general anesthesia. Thus, spinal anesthesia is a topic of growing interest for this group of patients. We hypothesized that spinal anesthesia is a feasible and safe option for inguinal hernia repair in infants even at high risk and cases of incarceration.

METHODS:

Between 2003 and 2013, we operated 100 infants younger than 6 months with inguinal hernia. Clinical data were collected prospectively and retrospectively analyzed. Patients were divided into two groups depending on anesthesia procedure (spinal anesthesia, Group 1 vs. general anesthesia, Group 2).

RESULTS:

Spinal anesthesia was performed in 69 infants, and 31 infants were operated in general anesthesia, respectively. In 7 of these 31 infants, general anesthesia was chosen because of lumbar puncture failure. Infants operated in spinal anesthesia were significantly smaller (54 ± 4 vs. 57 ± 4 cm; p = 0.001), had a lower body weight (4,047 ± 1,002 vs. 5,327 ± 1,376 g; p < 0.001) and higher rate of prematurity (26 vs. 4%; p = 0.017) compared to those operated in general anesthesia. No complications related to surgery or to anesthesia were found in both groups. The number of relevant preexisting diseases was higher in Group 1 (11 vs. 3%; p = 0.54). Seven of eight emergent incarcerated hernia repairs were performed in spinal anesthesia (p = 0.429).

CONCLUSIONS:

Spinal anesthesia is a feasible and safe option for inguinal hernia repair in infants, especially in high-risk premature infants and in cases of hernia incarceration.

• Authors: A Lambertz, G Schälte, J Winter, A Röth, D Busch, T F Ulmer, G Steinau, U P Neumann, C D Klink
• Journal: Pediatric surgery international (Pediatr Surg Int) Vol. 30 Issue 10 Pg. 1069-73 (Oct 2014) ISSN: 1437-9813 [Electronic] Germany
• PMID: 25185730 (Publication Type: Journal Article)

Topics

• Anesthesia, General (methods)
• Anesthesia, Spinal (methods)
• Emergencies
• Emergency Medical Services (methods)
• Feasibility Studies
• Female
• Hernia, Inguinal (surgery)
• Humans
• Infant
• Infant, Premature
• Infant, Premature, Diseases (surgery)
• Male
• Prospective Studies
• Retrospective Studies