Infant spinal anesthesia reduces postoperative pain scores and pain medication consumption in infants undergoing inguinal herniorrhaphy

Abstract

We appreciate the opportunity to comment on the study by Seifarth on the use of spinal anesthesia (SA) in infants undergoing inguinal hernia repair [ [1] Seifarth F. Spinal anesthesia for inguinal hernia repair in infants: a feasible and safe method even in emergency cases. J Ped Surg. 2015; 50: 890 Google Scholar ]. We agree that SA is a safe and effective alternative to general anesthesia (GA) in infants and is becoming a popular anesthetic method in infants undergoing infraumbilical surgery [ [1] Seifarth F. Spinal anesthesia for inguinal hernia repair in infants: a feasible and safe method even in emergency cases. J Ped Surg. 2015; 50: 890 Google Scholar , [2] Junkin C.I. Spinal anesthesia in children. Anesth Analg. 1935; 14: 91 Crossref Google Scholar ]. Infants who are younger than 60 weeks postmenstrual age are considered high-risk because they are particularly prone to the respiratory and cardiovascular side effects of GA due to their immature respiratory drive, higher oxygen metabolic demand, lower pulmonary reserve, and an upper airway prone to obstruction. Postoperative apnea is a common anesthetic complication in these high-risk infants where apneic episodes can lead to quick desaturation and subsequent bradycardia [ [3] Cote C.J. Zaslavsky A. Downes J.J. et al. Postoperative apnea in former preterm infants after inguinal herniorrhaphy: a combined analysis. Anesthesiology. 1995; 82: 809-822 Crossref PubMed Scopus (359) Google Scholar ]. Recently, several large studies have shown that SA decreases the risk of early postoperative apnea and bradycardia, maintains better intraoperative hemodynamic stability, and improves operating room (OR) and post-anesthesia recovery unit (PACU) efficiency compared to GA [ 4 Jones L.J. Craven P.D. Lakkundi A. et al. Regional (spinal, epidural, caudal) versus general anaesthesia in preterm infants undergoing inguinal herniorrhaphy in early infancy. Cochrane Database Syst Rev. 2015; 2015 Google Scholar , 5 Davidson A.J. Morton N.S. Arnup S.J. et al. Apnea after awake regional and general anesthesia in infants: the general anesthesia compared to spinal anesthesia study-comparing apnea and neurodevelopmental outcomes. a Randomized Controlled Trial. Anesthesiology. 2015; 123: 38-54 Google Scholar , 6 McCann M.E. Withington D.E. Arnup S.J. et al. Differences in Blood Pressure in Infants after General Anesthesia Compared to Awake Regional Anesthesia (GAS Study – a prospective randomized trial). Anesth Analg. 2017; 125: 837-845 Crossref PubMed Scopus (51) Google Scholar , 7 Liu C.A. Davis N. Kelleher C.M. Application of an infant spinal anesthesia protocol in infants presenting for inguinal herniorrhaphy improves operating room and postanesthesia recovery unit utilization. Pediatr Anesth. 2019; 29: 881-882 Crossref PubMed Scopus (2) Google Scholar ].