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Published on: January 31, 2025
Use of spinal anaesthesia in paediatric patients: a single centre experience with 1132 cases
Franco Puncuh1, Elisabetta Lampugnani, Hannu Kokki
1Department of Anaesthesiology and Intensive Care, G.Gaslini Children Hospital, L.go G.Gaslini, Genova, Italy. puncuh.arnau@libero.it
Insights
Spinal anaesthesia using hyperbaric bupivacaine is a safe and effective technique for pediatric lower body surgery. This study confirms its feasibility and highlights a low incidence of adverse effects in children.
Area of Science:
- Pediatric Anesthesiology
- Regional Anesthesia
- Surgical Procedures
Background:
- Spinal anesthesia has a long history in pediatric care, with increasing use in infants.
- Despite its established use, specific questions regarding its application in children remain.
Purpose of the Study:
- To evaluate the characteristics of spinal block in pediatric patients.
- To assess ease of performance, efficacy, adverse events, and complications.
Main Methods:
- A prospective study of 1132 children (6 months to 14 years) undergoing lower body surgery.
- Spinal block performed using 0.5% hyperbaric bupivacaine (0.2 mg/kg) with intravenous sedation.
- Informed consent and assent obtained; ethical approval secured.
Main Results:
- Spinal block demonstrated satisfactory efficacy, safety, and ease of performance in most pediatric patients.
- Supplementation was required in only 27 of 1132 children.
- Low incidence of complications, including hypotension (9/942 in <10 years, 8/190 in ≥10 years), postdural puncture headache (5/1132), and backache (9/1132). No other neurological complications were reported.
Conclusions:
- Spinal anesthesia with hyperbaric bupivacaine is a feasible and effective anesthetic method for pediatric lower body surgery.
- The technique is associated with a low rate of adverse effects and complications in this age group.
Background:
Spinal anaesthesia has been used in children for over 100 years and in the last two decades its popularity for newborns and infants has increased, but there are still unanswered questions with the technique.
Methods:
We evaluated the characteristics of spinal block including ease of performance, efficacy, adverse effects and complications in 1132 children, aged 6 months to 14 years, undergoing surgery in the lower part of the body. Local ethical committee approved the protocol of this prospective study, and parents gave written informed consent and older children their assent. All patients were sedated with midazolam, thiopental or propofol intravenously during spontaneous ventilation. No inhalation anaesthetics were used. Spinal block was performed with 0.5% hyperbaric bupivacaine at a dose of 0.2 mg x kg(-1).
Results:
Efficacy, safety and ease of performance of the spinal block were shown to be satisfactory in most children. Only 27 of the 1132 children needed any supplementation. The incidence and severity of complications was low. Only nine of 942 children, < 10 years of age and eight of 190 children, 10 years or older, developed hypotension. The incidences of postdural puncture headache, in five of the 1132 children, and backache, in nine of the 1132, were low. No other neurological complications were reported.
Conclusions:
Spinal anaesthesia with hyperbaric bupivacaine is a feasible anaesthetic method in children for surgery in the lower part of the body.
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