title: Spinal anesthesia for inguinal hernia repair in infants: a feasible and safe method even in emergency cases.
abstract: BACKGROUND
  Inguinal hernia repair is the most frequently performed surgical procedure in infants and children. Especially in premature infants, prevalence reaches up to 30% in coincidence with high rates of incarceration during the first year of life. These infants carry an increased risk of complications due to general anesthesia. Thus, spinal anesthesia is a topic of growing interest for this group of patients. We hypothesized that spinal anesthesia is a feasible and safe option for inguinal hernia repair in infants even at high risk and cases of incarceration.
  
  
  METHODS
  Between 2003 and 2013, we operated 100 infants younger than 6 months with inguinal hernia. Clinical data were collected prospectively and retrospectively analyzed. Patients were divided into two groups depending on anesthesia procedure (spinal anesthesia, Group 1 vs. general anesthesia, Group 2).
  
  
  RESULTS
  Spinal anesthesia was performed in 69 infants, and 31 infants were operated in general anesthesia, respectively. In 7 of these 31 infants, general anesthesia was chosen because of lumbar puncture failure. Infants operated in spinal anesthesia were significantly smaller (54 ± 4 vs. 57 ± 4 cm; p = 0.001), had a lower body weight (4,047 ± 1,002 vs. 5,327 ± 1,376 g; p < 0.001) and higher rate of prematurity (26 vs. 4%; p = 0.017) compared to those operated in general anesthesia. No complications related to surgery or to anesthesia were found in both groups. The number of relevant preexisting diseases was higher in Group 1 (11 vs. 3%; p = 0.54). Seven of eight emergent incarcerated hernia repairs were performed in spinal anesthesia (p = 0.429).
  
  
  CONCLUSIONS
  Spinal anesthesia is a feasible and safe option for inguinal hernia repair in infants, especially in high-risk premature infants and in cases of hernia incarceration.
authors.affiliation: Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany, alambertz@ukaachen.de.
authors.forename: A
authors.initials: A
authors.lastname: Lambertz
authors.forename: G
authors.initials: G
authors.lastname: Schälte
authors.forename: J
authors.initials: J
authors.lastname: Winter
authors.forename: A
authors.initials: A
authors.lastname: Röth
authors.forename: D
authors.initials: D
authors.lastname: Busch
authors.forename: T F
authors.initials: TF
authors.lastname: Ulmer
authors.forename: G
authors.initials: G
authors.lastname: Steinau
authors.forename: U P
authors.initials: UP
authors.lastname: Neumann
authors.forename: C D
authors.initials: CD
authors.lastname: Klink
mesh_terms: D000768:Anesthesia, General / Q000379:methods; D000775:Anesthesia, Spinal / Q000379:methods*; D004630:Emergencies; D004632:Emergency Medical Services / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D007223:Infant; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000601:surgery*; D008297:Male; D011446:Prospective Studies; D012189:Retrospective Studies