Success rates and complications of awake caudal versus spinal block in preterm infants undergoing inguinal hernia repair: A prospective study

Abstract

Background:Inguinal hernia is a common disease in preterm infants necessitating surgical repair. Despite the increased risk of postoperative apnea in preterm infants, the procedure was conventionally performed under general anesthesia. Recently, regional anesthesia approaches, including spinal and caudal blocks have been proposed as safe and efficient alternative anesthesia methods in this group of patients. The current study evaluates awake caudal and spinal blocks in preterm infants undergoing inguinal hernia repair.Materials and Methods:In a randomized clinical trial, 66 neonates and infants (weight <5 kg) undergoing inguinal hernia repair were recruited in Tabriz Teaching Children Hospital during a 12-month period. They were randomly divided into two equal groups; receiving either caudal block by 1 ml/kg of 0.25% bupivacaine plus 20 μg adrenaline (group C) or spinal block by 1 mg/kg of 0.5% bupivacaine plus 20 μg adrenaline (group S). Vital signs and pain scores were documented during operation and thereafter up to 24 h after operation.Results:Decrease in heart rate and systolic blood pressure was significantly higher in group C throughout the study period (P < 0.05). The mean recovery time was significantly higher in group S (27.3 ± 5.5 min vs. 21.8 ± 9.3 min; P = 0.03). Postoperative need for analgesia was significantly more frequent in group S (75.8% vs. 36.4%; P = 0.001). Failure in anesthesia was significantly higher in group S (24.4% vs. 6.1%; P = 0.04).Conclusion:More appropriate success rate, duration of recovery and postoperative need of analgesics could contribute to caudal block being a superior anesthesia technique compared to spinal anesthesia in awaked preterm infants undergoing inguinal hernia repair.

Use of Spinal Anaesthesia in Neonates and Infants in Antananarivo, Madagascar: A Retrospective Descriptive Study

“…In the present study, no complementary local anesthesia by the surgeon was required and the GA conversion was 5.8%. This failure rate was similar to literature, varying from 1.04% to 24.6% [7,9,17,19]. Dohms K. et al [19] nd a failure rate of 7.5% and 16% required supplemental anesthesia, also more than two punctures were needed in 28%.…”

“…The most commonly used local anesthetics are tetracaine 0.5% and bupivacaine 0.5% lasting 90 to 120 minutes [1]. Hyperbaric bupivacaine (0.5%) is mostly used in a dose from 0.3 mg/kg to 1 mg/kg [1,6,13,17].…”

Use of Spinal Anaesthesia in Neonates and Infants in Antananarivo, Madagascar: A Retrospective Descriptive Study

“…The most used local anesthetics are tetracaine 0.5% and bupivacaine 0.5% lasting 90 to 120 minutes [1]. Hyperbaric bupivacaine (0.5%) is mostly used in a dose from 0.3 mg/kg to 1 mg/kg [1,6,13,17].…”

The success rate and complications of awake caudal epidural bupivacaine alone or in combination with intravenous midazolam and ketamine in pre-term infants

“…None of the subjects in our study suffered from apnoea, nausea, vomiting or a decrease in arterial oxygen saturation that was consistent with Seyedhejazi's findings. [ 24 ]…”