Background:Post-operative apnea in the neonate is a major concern after surgery. Spinal anesthesia has many advantages, such as minimal cardiorespiratory disturbances1. We describe a successful use of spinal anesthesia in a neonate undergoing inguinal hernia repair.
Case Report:A 33 weeks post-conceptional age premature (born with 26 weeks 5 days) boy, 1800g, with pulmonary hypertension and bronchopulmonary dysplasia, ASA III, was scheduled for a left inguinal hernia repair. The anesthetic procedure was explained and parental informed consent obtained. After arrival to the operating room, he was monitored according to ASA standard and sedation with sevoflurane 2% was initiated. The patient was then positioned in left lateral decubitus and an ultrasound-guided spinal
anesthesia lumbar approach technique was performed with a 29G 35mm Quincke spinal needle and 0.55mg/kg bupivacaine 0.5% administered into the subarachnoid space. The patient was positioned in dorsal decubitus and surgery started while spontaneously breathing (FiO2 0.5). Hemodynamic and respiratory stability were maintained throughout the surgery that lasted 50 minutes. At the end of the procedure, under ultrasound guidance, an ilioinguinal and iliohypogastric nerve block was performed and 0.2ml/kg of ropivacaine 0.05% administered. The patient was safely transferred to the neonatal care unit.
Discussion:Spinal anaesthesia is a well-accepted anaesthetic technique for ex-premature infants undergoing infraumbilical surgery. One of its major advantages over general anaesthesia is to minimize the risk for postoperative apnoea and the need for ventilatory support. Furthermore, a major concern related to neuraxial techniques in small babies is the risk of potential spinal cord injury during the technique2. This is minimized with the use of direct-vision ultrasound guidance. The ilioinguinal and iliohypogastric nerve block
provides post-operative pain relief after inguinal incisions and avoids the use of systemic opioids.
Learning points: Combining ultrasound guided spinal anesthesia with ilioinguinal and iliohypogastric nerve block is a good anesthetic option for inguinal hernia repair in the neonate/infant.

10 / Just keep breathing: spinal anesthesia in the extremely premature infant