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

Abstract

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.

Inguinal hernia repair in preterm neonates: is there evidence that spinal or general anaesthesia is the better option regarding intraoperative and postoperative complications? A systematic review and meta-analysis

“…Comparing our findings to others, we observed variation in the failure rate, ranging from 3%40 to 15% 17. Lambertz et al 31 emphasised the anaesthesiologist’s experience as essential to ensure the maximum success rate. Overall, regarding these experiences performing spinal blocks for inguinal hernia repair, we conclude that SA is a safe method.…”

“…Significant heterogeneity was detected for hospital stay duration (I 2 =77%). The sensitivity analysis of the hospital stay revealed that lower heterogeneity occurred (I 2 =42%) when Lambertz et al 31 was removed for this measure; however, excluding that study did not alter the fact that no significant difference between SA and GA was observed. The definition of hospital stay was not consistent, which was probably the main reason for the marked heterogeneity.…”

“…Our risk of bias analysis provides an indication of publication bias. All studies except Kim et al 30 and Lambertz et al 31 assigned the patients randomly to the groups, but the process of random sequence generation was described in only one study 17. The participants were easily blinded because the surgery was performed on infants born preterm, but procedural blinding was not possible due to the anaesthetists’ interventions.…”

“…In total, 7.5% (95% CI: 0.04 to 0.12) of the patients undergoing SA (15 of 200 patients) were converted to GA (online supplementary table 2). In total, 28% (95% CI: 0.21 to 0.37) received more than one puncture (54 of 191 patients)17 19 33 and 16% (95% CI: 0.10 to 0.25) required supplemental anaesthesia (11 of 29 patients) 17 19 31. Davidson et al 17 reported one case of high spinal block that required manual ventilation.…”

Inguinal hernia repair in preterm neonates: is there evidence that spinal or general anaesthesia is the better option regarding intraoperative and postoperative complications? A systematic review and meta-analysis

“…Comparing our findings to others, we observed variation in the failure rate, ranging from 3%40 to 15% 17. Lambertz et al 31 emphasised the anaesthesiologist’s experience as essential to ensure the maximum success rate. Overall, regarding these experiences performing spinal blocks for inguinal hernia repair, we conclude that SA is a safe method.…”

“…Significant heterogeneity was detected for hospital stay duration (I 2 =77%). The sensitivity analysis of the hospital stay revealed that lower heterogeneity occurred (I 2 =42%) when Lambertz et al 31 was removed for this measure; however, excluding that study did not alter the fact that no significant difference between SA and GA was observed. The definition of hospital stay was not consistent, which was probably the main reason for the marked heterogeneity.…”

“…Our risk of bias analysis provides an indication of publication bias. All studies except Kim et al 30 and Lambertz et al 31 assigned the patients randomly to the groups, but the process of random sequence generation was described in only one study 17. The participants were easily blinded because the surgery was performed on infants born preterm, but procedural blinding was not possible due to the anaesthetists’ interventions.…”

“…In total, 7.5% (95% CI: 0.04 to 0.12) of the patients undergoing SA (15 of 200 patients) were converted to GA (online supplementary table 2). In total, 28% (95% CI: 0.21 to 0.37) received more than one puncture (54 of 191 patients)17 19 33 and 16% (95% CI: 0.10 to 0.25) required supplemental anaesthesia (11 of 29 patients) 17 19 31. Davidson et al 17 reported one case of high spinal block that required manual ventilation.…”

Efficacy and Safety of Dexmedetomidine Combined with Bupivacaine in Infants’ Surgeries: A Randomized Controlled Trial

“…One of the limitations of bupivacaine alone in SA is that it provides a block that is of shorter duration in infants and children. Therefore, to prolong the duration of SA, several adjuvants such as epinephrine, ne-ostigmine, clonidine, morphine, fentanyl, and dexmedetomidine are added to bupivacaine (9) . So our study was conducted to determine the safety and efficacy of dexmedetomidine as an adjuvant to intrathecal hyperbaric bupivacaine in infants undergoing infra-umbilical surgeries at Suez Canal University Hospitals.…”

Inguinal hernia repair in preterm neonates: is there evidence that spinal or general anaesthesia is the better option regarding intraoperative and postoperative complications? A systematic review and meta-analysis

“…Comparing our findings to others, we observed variation in the failure rate, ranging from 3%40 to 15% 17. Lambertz et al 31 emphasised the anaesthesiologist’s experience as essential to ensure the maximum success rate. Overall, regarding these experiences performing spinal blocks for inguinal hernia repair, we conclude that SA is a safe method.…”

“…Significant heterogeneity was detected for hospital stay duration (I 2 =77%). The sensitivity analysis of the hospital stay revealed that lower heterogeneity occurred (I 2 =42%) when Lambertz et al 31 was removed for this measure; however, excluding that study did not alter the fact that no significant difference between SA and GA was observed. The definition of hospital stay was not consistent, which was probably the main reason for the marked heterogeneity.…”

“…Our risk of bias analysis provides an indication of publication bias. All studies except Kim et al 30 and Lambertz et al 31 assigned the patients randomly to the groups, but the process of random sequence generation was described in only one study 17. The participants were easily blinded because the surgery was performed on infants born preterm, but procedural blinding was not possible due to the anaesthetists’ interventions.…”

“…In total, 7.5% (95% CI: 0.04 to 0.12) of the patients undergoing SA (15 of 200 patients) were converted to GA (online supplementary table 2). In total, 28% (95% CI: 0.21 to 0.37) received more than one puncture (54 of 191 patients)17 19 33 and 16% (95% CI: 0.10 to 0.25) required supplemental anaesthesia (11 of 29 patients) 17 19 31. Davidson et al 17 reported one case of high spinal block that required manual ventilation.…”

Efficacy and Safety of Dexmedetomidine Combined with Bupivacaine in Infants’ Surgeries: A Randomized Controlled Trial

“…One of the limitations of bupivacaine alone in SA is that it provides a block that is of shorter duration in infants and children. Therefore, to prolong the duration of SA, several adjuvants such as epinephrine, ne-ostigmine, clonidine, morphine, fentanyl, and dexmedetomidine are added to bupivacaine (9) . So our study was conducted to determine the safety and efficacy of dexmedetomidine as an adjuvant to intrathecal hyperbaric bupivacaine in infants undergoing infra-umbilical surgeries at Suez Canal University Hospitals.…”

Inguinal hernia repair in preterm neonates: is there evidence that spinal or general anaesthesia is the better option regarding intraoperative and postoperative complications? A systematic review and meta-analysis

“…Comparing our findings to others, we observed variation in the failure rate, ranging from 3%40 to 15% 17. Lambertz et al 31 emphasised the anaesthesiologist’s experience as essential to ensure the maximum success rate. Overall, regarding these experiences performing spinal blocks for inguinal hernia repair, we conclude that SA is a safe method.…”

“…Significant heterogeneity was detected for hospital stay duration (I 2 =77%). The sensitivity analysis of the hospital stay revealed that lower heterogeneity occurred (I 2 =42%) when Lambertz et al 31 was removed for this measure; however, excluding that study did not alter the fact that no significant difference between SA and GA was observed. The definition of hospital stay was not consistent, which was probably the main reason for the marked heterogeneity.…”

“…Our risk of bias analysis provides an indication of publication bias. All studies except Kim et al 30 and Lambertz et al 31 assigned the patients randomly to the groups, but the process of random sequence generation was described in only one study 17. The participants were easily blinded because the surgery was performed on infants born preterm, but procedural blinding was not possible due to the anaesthetists’ interventions.…”

“…In total, 7.5% (95% CI: 0.04 to 0.12) of the patients undergoing SA (15 of 200 patients) were converted to GA (online supplementary table 2). In total, 28% (95% CI: 0.21 to 0.37) received more than one puncture (54 of 191 patients)17 19 33 and 16% (95% CI: 0.10 to 0.25) required supplemental anaesthesia (11 of 29 patients) 17 19 31. Davidson et al 17 reported one case of high spinal block that required manual ventilation.…”

Efficacy and Safety of Dexmedetomidine Combined with Bupivacaine in Infants’ Surgeries: A Randomized Controlled Trial

“…One of the limitations of bupivacaine alone in SA is that it provides a block that is of shorter duration in infants and children. Therefore, to prolong the duration of SA, several adjuvants such as epinephrine, ne-ostigmine, clonidine, morphine, fentanyl, and dexmedetomidine are added to bupivacaine (9) . So our study was conducted to determine the safety and efficacy of dexmedetomidine as an adjuvant to intrathecal hyperbaric bupivacaine in infants undergoing infra-umbilical surgeries at Suez Canal University Hospitals.…”