Combined spinal and epidural anaesthesia for inguinal hernia repair in babies

Abstract

We describe combined subarachanoid-epidural anaesthesia for inguinal herniotomy in eight ex-premature babies less than 47 weeks postconception and one full-term baby aged 21 weeks who had Pierre-Robin syndrome. No additional anaesthetic supplements were needed during surgery. Motor block was profound and operating conditions were excellent. One baby had brief self-limiting bradycardias shortly after lumbar puncture. A second baby with severe bronchopulmonary dysplasia had recurrent oxygen desaturations associated with apnoea during surgery. There were no other intra-or postoperative complications. All babies were fed immediately on return to the ward. We conclude that combined subarachoid-epidural anaesthesia is a satisfactory technique for anaesthesia for inguinal herniotomy in babies at risk of apnoea after surgery.

Epidural and subarachnoid blockade in children

“…This was presumably caused by the local anaesthetic solution in the epidural space compressing the lumbar cerebrospinal fluid and causing the subarachnoid local anaesthetic to migrate cephalad (Table 6). Because of the limitations of subarachnoid blockade in neonates, attempts have been made to use alternatives such as one-shot caudal epidural blockade [180,181], lumbar epidural blockade [58], combined spinal and epidural techniques [157] and continuous caudal epidural blockade using an epidural catheter [59]. All of these techniques have been used in relatively few patients although descriptions are encouraging.…”

Spinal anaesthesia for inguinal herniotomy in preterm infants sedated with nitrous oxide: a comparison of lumbar puncture in the lateral or sitting position

“…One patient in the lateral group who had bilateral herniae was given halothane 0.5% in addition to the nitrous oxide in oxygen because of prolonged surgery. The median [range] number of attempts at lumbar puncture was 1 [1][2][3] in the lateral group and 1 [1][2][3] [11][12][13][14][15][16][17][18][19][20][21][22][23] min for unilateral herniae and 38 [30-42] min for bilateral herniae. There were no statistically significant differences in haemodynamic data between the groups before or after spinal block ( Table 2).…”

“…Local anaesthetic doses should be correlated with body weight in children [13,[21][22][23]. Doses of bupivacaine in the range 0.78-0.87 mg.kg )1 should be used in infants < 6 months old [13].…”

“…We used epinephrine 1 : 200 000 because it has been shown to increase block duration [4,26]. The dose of bupivacaine was chosen according to the recommendations of Beauvoir et al [21] and Peutrel & Hughes [22]. More recently, Murat [23] has recommended doses of 3 mg in patients < 2 kg, and 4 mg for patients weighing 2-5 kg.…”

Spinal anaesthesia in paediatric patients

“…Combined spinal-epidural technique was suggested first by Peutrell and Hughes [10] and later by Williams et al [11] and Kokki et al [12] to extend the short duration of single-shot spinal anaesthesia and to obtain a longer postoperative analgesia. Combined spinal-caudal epidural anaesthesia has been proposed by Cassidy and Lederhaas [13] for bilateral inguinal herniorrhaphy.…”