Awake neuraxial anesthesia for infants undergoing infraumbilical surgery.

Abstract

Awake neuraxial anesthesia techniques such as spinal anesthesia (SA) have been recently popularized and successfully used in infants for infraumbilical procedures. One caveat of these techniques is limited block duration. In this prospective study, we describe our single-center implementation of three approaches to awake neuraxial anesthesia (plain bupivacaine SA, bupivacaine with adjunctive clonidine SA, and combined spinal caudal anesthesia) based on expected surgical duration in 140 infants. We show that a wide range of infraumbilical procedures can be successfully performed in infants while maintaining the benefits of awake neuraxial anesthesia techniques. We hope our experience provides guidance to clinicians performing awake neuraxial anesthesia in infants in helping plan the appropriate anesthetic approach.