Lumbar epidural anaesthesia for inguinal hernia repair in low birth weight infants

Abstract

In view of the complications of general, spinal, and caudal anaesthesia for inguinal hernia repair in high-risk neonates, an evaluation of lumbar epidural anaesthesia (LEA) was undertaken to assess its technical feasibility, effectiveness and incidence of complications. In 18 consecutive cases, gestational age 26 ±2.6 wk, birth weight 877 ±310 g, 16 (89%) had bronchopulmonary dysplasia and 12 (67%) were oxygen-dependent at the time of surgery. Using a standard loss of resistance technique and a 4.0 cm 20 G epidural needle, the epidural space was positively identified on the first attempt in 16 (89%), and on the second attempt in 2 patients (11%). Reflux of 0.9% saline used to identify the epidural space was blood tinged in two cases. Epidural analgesia was achieved in all cases with bupivacaine 0-25% with and without 1:200,000 epinephrine, 0.75 ml · kg-1 for the first two cases, and subsequently 1.0 ml · kg-1~'. In 15 patients (83%), good operating conditions were achieved with epidural analgesia alone. Inhalational anaesthesia supplementation was necessary in three cases (17%). In the first two patients, the level of analgesia (T8) was insufficient to control the response to traction on the hernial sac. In one infant, analgesic to T4, whose surgery was inadvertently delayed for four hours, inhalation anaesthesia was needed to control restlessness rather than pain. Ten infants were analgesic to T2, four to T4, two to T6 and two to Tg. Intraoperative periodic breathing was seen in seven infants (39%), four with oxyhaemoglobin desaturation to 75%, and two to 85%. All responded to increased F1O2. No adverse haemodynamic effects were seen. Apnoeic spells in the first 24 hr after surgery occurred in three infants; one of these infants also had apnoeic spells during the previous 24 hr. Otherwise, there were no postoperative complications. We conclude that LEA was technically easy, and provided good operating conditions for most neonates in this study. © 1993 Canadian Anesthesiologists.