Reduction of incarcerated inguinal hernia in infants using caudal epidural anaesthesia
N Brindley1, R Taylor, S Brown
1Department of Paediatric Surgery, Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland. nicola.brindley@yorkhill.scot.nhs.uk
Insights
Caudal epidural anesthesia effectively reduces incarcerated inguinal hernias in infants, avoiding risks associated with intravenous sedation. This method is particularly beneficial for premature infants, offering a safer alternative for hernia reduction.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Neonatology
Background:
- Incarcerated inguinal hernias are common in infants.
- Intravenous sedation with opiates for reduction carries risks like apnea, especially in premature infants.
- Caudal epidural anesthesia is standard for elective inguinal herniotomy analgesia.
Purpose of the Study:
- To evaluate the efficacy of caudal epidural anesthesia for non-operative reduction of incarcerated inguinal hernias in infants.
- To determine if this method can avoid the need for intravenous sedation in acute settings.
Main Methods:
- Retrospective review of 12 male infants with irreducible, incarcerated inguinal hernias.
- Attempted non-operative reduction using caudal epidural anesthesia with Bupivacaine (0.25%) after failed initial attempts without sedation.
- Data collected on patient age, gestational age, and reduction success.
Main Results:
- Successful non-operative reduction of incarcerated inguinal hernias was achieved in all 12 infants using caudal epidural anesthesia.
- The infants' ages ranged from 2 to 17 weeks, with a median gestational age of 36 weeks.
- No complications related to the procedure were reported.
Conclusions:
- Caudal epidural anesthesia is a safe, feasible, and effective technique for reducing incarcerated inguinal hernias in infants.
- This method is particularly advantageous for low-birth weight and premature infants, mitigating risks of opiate-based sedation.
Abstract:
Incarcerated inguinal hernias in infants are commonly encountered. Reduction with intravenous sedation using morphine and related drugs carries risks of apnoea and/or respiratory arrest, especially in small, ex-premature babies who have an increased incidence of incarceration and thus opiate use is best avoided. Caudal epidural anaesthesia is widely used as pre- and post-operative analgesia in elective inguinal herniotomy in infants. In this study we sought to determine if caudal epidural anaesthesia would allow reduction of an incarcerated inguinal hernia in the acute setting, thereby obviating the need for intravenous sedation. A retrospective review of 12 male infants, with irreducible, incarcerated inguinal hernias was done. Each hernia was successfully reduced with the help of caudal epidural anaesthesia. This group of babies was treated at The Royal Belfast Hospital for Sick Children. Twelve male infants were identified with an incarcerated inguinal hernia in whom attempted reduction, without sedation had failed. Using Bupivacaine (1 ml/kg 0.25%), placed into the caudal space, these hernias were successfully reduced non-operatively. Ages at presentation ranged from 2 to 17 weeks with a median gestational age of 36 weeks (range 29-39 weeks). Caudal epidural anaesthesia is a safe, feasible and effective method of achieving reduction of irreducible, incarcerated inguinal hernias. It is especially useful in low-birth weight, premature infants where intravenous opiate sedation is best avoided.
