DefinePK

Abstract

Background & objectives: Although spinal anesthesia (SA) has largely replaced general anesthesia (GA) for inguinal herniorrhaphy (IH), the anesthetist might be compelled to go for GA in some special cases, including patient refusal to have SA, or neonates, young children or female patients. We conducted this study to compare the efficacy of SA and GA in neonates undergoing inguinal herniorrhaphy (IH).
Methodology: This randomized controlled study was conducted on 74 neonates classified as American Society of Anesthesiology physical status I-II undergoing IH. The patients were randomized equally into two groups. GA group: GA was maintained with 2% sevoflurane. SA group: SA was performed using 0.6 mg/kg of bupivacaine 0.5%. The patients were sedated by administering intermittent injections of ketamine 1 mg, as required. Oxygen was administeredthrough a nasal cannula.
Results: The heart rate measurements were significantly higher, and mean arterial blood pressure measurements were significantly lower at 20, 30, 40, 50, and 60min intraoperatively, 30, 60, 90, and 120min in PACU in the SA in comparison to GA group (P < 0.05). Oxygen (O2) saturation measurements were significantly higher at 30, 60, 90, and 120 min in PACU in the SA in comparison to the GA group (P < 0.05). There was no discernible variation within both groups in the incidence of bradycardia, hypotension, the need for postoperative O2 supplementation, and hospital stays. The incidence of apnea was substantially decreased in the SA group compared to the GA group (12 (32.43%) vs 4 (10.81%), P = 0.045).
Conclusions: SA is a viable alternative for GA in neonates undergoing IH, as it offers better hemodynamic and O2 saturation stability and reduces postoperative apnea.
Abbreviations: IH: inguinal herniorrhaphy, GA: general anesthesia, PACU: post-anesthesia care unit SA: spinal anesthesia,
Keywords: Spinal anesthesia; General anesthesia; Herniorrhaphy; Neonates; Heart rate
Citation: Abo ElKheir AE, ElSharkawy MS, Abd El Aziz MH, Hamama K, Elfert MAE. A randomized controlled trial comparing spinal and general anesthesia in neonates undergoing inguinal herniorrhaphy. Anaesth. pain intensive care 2025;29(3):397-402. DOI: 10.35975/apic.v29i3.2769
Received: December 09, 2024; Revised: February 08, 2025; Accepted: February 08, 2025