title: Regional block via continuous caudal infusion as sole anesthetic for inguinal hernia repair in conscious neonates.
abstract: OBJECTIVE
  The use of general anesthesia in young children has come under increasing scrutiny due to its potential long-term neurotoxic effects. Meanwhile, regional anesthesia for surgical procedures in neonates has many advantages, including preservation of respiratory status and faster return to feeding. We describe the successful use of 3% 2-chloroprocaine administered via continuous caudal infusion as the sole anesthetic agent during elective surgical procedures in infants.
  
  
  METHODS
  A retrospective chart review of all patients who underwent elective surgical procedures under continuous caudal regional anesthetic at a single institution was performed. Thirty patients (27 males, three females) were identified: 28 patients underwent inguinal hernia repairs. Caudal anesthesia was established via continuous infusion of 3% 2-chloroprocaine through an indwelling catheter.
  
  
  RESULTS
  Successful analgesia by regional block alone was achieved in all patients for the duration of each surgical procedure without need for rescue anesthesia. Mean operative time was 49 min. Patients were able to return to feeding immediately after surgery and were ready for discharge home within that day.
  
  
  CONCLUSIONS
  Continuous caudal infusion of chloroprocaine is a safe and effective way to maintain adequate analgesia for elective surgeries in infants. This successful regional approach obviates the use of general anesthetic which reduces post-operative recovery time and avoids concerns for neurotoxicity.
authors.affiliation: Division of Pediatric Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Alway Building M116, MC: 5733, Stanford, CA, 94305, USA. clmueller@lpch.org.
authors.forename: Claudia M
authors.initials: CM
authors.lastname: Mueller
authors.affiliation: Division of Pediatric Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Alway Building M116, MC: 5733, Stanford, CA, 94305, USA.
authors.forename: Tiffany J
authors.initials: TJ
authors.lastname: Sinclair
authors.affiliation: Division of Pediatric Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Alway Building M116, MC: 5733, Stanford, CA, 94305, USA.
authors.forename: Megan
authors.initials: M
authors.lastname: Stevens
authors.affiliation: Division of Pediatric Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Alway Building M116, MC: 5733, Stanford, CA, 94305, USA.
authors.forename: Micaela
authors.initials: M
authors.lastname: Esquivel
authors.affiliation: Department of Anesthesiology, California Pacific Medical Center, 3700 California Street, San Francisco, CA, 94118, USA.
authors.forename: Noah
authors.initials: N
authors.lastname: Gordon
mesh_terms: D000763:Anesthesia, Caudal / Q000379:methods; D000765:Anesthesia, Conduction / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D008297:Male; D011343:Procaine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D012189:Retrospective Studies
chemical_list: D000779:Anesthetics, Local; D011343:Procaine; C004616:chloroprocaine
keywords: Continuous caudal infusion; Neonatal surgery; Regional anesthesia