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Awake spinal or caudal anaesthesia in preterms for herniotomies: what is the evidence based benefit compared with

Andreas C Gerber1, Markus Weiss

  • 1Department of Anaesthesia, University Children's Hospital, Zurich, Switzerland. andreas.gerber@kispi.unizh.ch

Current Opinion in Anaesthesiology
|October 6, 2006
PubMed

Insights

Postoperative apnoea is a risk for preterm infants undergoing inguinal hernia surgery. While awake regional anesthesia may offer benefits, current evidence is insufficient to make definitive recommendations for its use.

Area of Science:

  • Pediatric Anesthesiology
  • Surgical Risk Management
  • Neonatal Care

Background:

  • Postoperative apnoea poses a significant threat to preterm and ex-preterm infants undergoing inguinal hernia repair.
  • Awake regional anesthesia techniques, including spinal and caudal anesthesia, have been proposed to mitigate these risks.
  • Despite proposed benefits, many herniotomies in this population are still performed under general anesthesia without apparent adverse outcomes.

Purpose of the Study:

  • To review and analyze the existing evidence on anesthesia techniques for inguinal hernia surgery in preterm infants.
  • To compare the efficacy and safety of awake regional anesthesia versus general anesthesia in this vulnerable patient group.
  • To provide a balanced perspective on the use of awake regional anesthesia, considering both its potential advantages and limitations.

Main Methods:

  • Systematic review of studies published since 1984 concerning anesthesia for inguinal hernia repair in preterm infants.
  • Evaluation of evidence comparing awake regional anesthesia (spinal, caudal) with general anesthesia.
  • Consideration of advancements in pediatric general anesthesia and perioperative care.

Main Results:

  • The available evidence is limited and does not permit definitive conclusions or recommendations.
  • While some studies suggest awake regional anesthesia is superior, its successful implementation requires specialized expertise.
  • Modern light general anesthesia combined with caudal blocks significantly reduces the incidence of postoperative apnoea.

Conclusions:

  • Unequivocal conclusions regarding the superiority of awake regional anesthesia cannot be drawn due to insufficient evidence.
  • Awake regional anesthesia for preterm infant herniotomy demands significant technical skill and commitment.
  • Combining light general anesthesia with caudal blocks offers a safe alternative, minimizing postoperative apnoea risk with effective monitoring and management.
Abstract

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