Top

Pediatric Surgery International

Published in:

01-03-2017 | Original Article

Regional block via continuous caudal infusion as sole anesthetic for inguinal hernia repair in conscious neonates

Authors: Claudia M. Mueller, Tiffany J. Sinclair, Megan Stevens, Micaela Esquivel, Noah Gordon

Published in: Pediatric Surgery International | Issue 3/2017

Abstract

Purpose

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.

Conclusion

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.

Pan ML, Chang WP, Lee HC, Tsai HL, Liu CS, Liou DM, Sung YJ, Chin TW (2013) A longitudinal cohort study of incidence rates of inguinal hernia repair in 0- to 6-year-old children. J Pediatr Surg 48(11):2327–2331. doi:10.1016/j.jpedsurg.2013.06.004 CrossRefPubMed

Cote CJ, Zaslavsky A, Downes JJ, Kurth CD, Welborn LG, Warner LO, Malviya SV (1995) Postoperative apnea in former preterm infants after inguinal herniorrhaphy. A combined analysis. Anesthesiology 82(4):809–822CrossRefPubMed

William JM, Stoddart PA, Williams SA, Wolf AR (2001) Post-operative recovery after inguinal herniotomy in ex-premature infants: comparison between sevoflurane and spinal anaesthesia. Br J Anaesth 86(3):366–371CrossRefPubMed

Somri M, Gaitini L, Vaida S, Collins G, Sabo E, Mogilner G (1998) Postoperative outcome in high-risk infants undergoing herniorrhaphy: comparison between spinal and general anaesthesia. Anaesthesia 53(8):762–766CrossRefPubMed

Davidson AJ, Morton NS, Arnup SJ, de Graaff JC, Disma N, Withington DE, Frawley G, Hunt RW, Hardy P, Khotcholava M, von Ungern Sternberg BS, Wilton N, Tuo P, Salvo I, Ormond G, Stargatt R, Locatelli BG, McCann ME, General Anesthesia compared to Spinal anesthesia C (2015) Apnea after awake regional and general anesthesia in infants: the general anesthesia compared to spinal anesthesia study-comparing apnea and neurodevelopmental outcomes, a randomized controlled trial. Anesthesiology 123(1):38–54. doi:10.1097/ALN.0000000000000709 CrossRefPubMedPubMedCentral

Culley DJ, Maze M, Crosby G (2012) Reprogramming of the infant brain by surgery with general anesthesia. Mayo Clin Proc 87(2):110–113. doi:10.1016/j.mayocp.2012.01.001 CrossRefPubMedPubMedCentral

Sun L (2010) Early childhood general anaesthesia exposure and neurocognitive development. Br J Anaesth 105(Suppl 1):i61–i68. doi:10.1093/bja/aeq302 CrossRefPubMedPubMedCentral

Rappaport B, Mellon RD, Simone A, Woodcock J (2011) Defining safe use of anesthesia in children. N Engl J Med 364(15):1387–1390. doi:10.1056/NEJMp1102155 CrossRefPubMed

DiMaggio C, Sun LS, Kakavouli A, Byrne MW, Li G (2009) A retrospective cohort study of the association of anesthesia and hernia repair surgery with behavioral and developmental disorders in young children. J Neurosurg Anesthesiol 21(4):286–291. doi:10.1097/ANA.0b013e3181a71f11 CrossRefPubMedPubMedCentral

10.

Wilder RT, Flick RP, Sprung J, Katusic SK, Barbaresi WJ, Mickelson C, Gleich SJ, Schroeder DR, Weaver AL, Warner DO (2009) Early exposure to anesthesia and learning disabilities in a population-based birth cohort. Anesthesiology 110(4):796–804. doi:10.1097/01.anes.0000344728.34332.5d CrossRefPubMedPubMedCentral

11.

Flick RP, Katusic SK, Colligan RC, Wilder RT, Voigt RG, Olson MD, Sprung J, Weaver AL, Schroeder DR, Warner DO (2011) Cognitive and behavioral outcomes after early exposure to anesthesia and surgery. Pediatrics 128(5):e1053–e1061. doi:10.1542/peds.2011-0351 CrossRefPubMedPubMedCentral

12.

Sprung J, Flick RP, Katusic SK, Colligan RC, Barbaresi WJ, Bojanic K, Welch TL, Olson MD, Hanson AC, Schroeder DR, Wilder RT, Warner DO (2012) Attention-deficit/hyperactivity disorder after early exposure to procedures requiring general anesthesia. Mayo Clin Proc 87(2):120–129. doi:10.1016/j.mayocp.2011.11.008 CrossRefPubMedPubMedCentral

13.

Moriarty A (2012) Pediatric epidural analgesia (PEA). Paediatr Anaesth 22(1):51–55. doi:10.1111/j.1460-9592.2011.03731.x CrossRefPubMed

14.

Aram L, Krane EJ, Kozloski LJ, Yaster M (2001) Tunneled epidural catheters for prolonged analgesia in pediatric patients. Anesth Analg 92(6):1432–1438CrossRefPubMed

15.

Johr M, Berger TM (2012) Caudal blocks. Paediatr Anaesth 22(1):44–50. doi:10.1111/j.1460-9592.2011.03669.x CrossRefPubMed

16.

Uguralp S, Mutus M, Koroglu A, Gurbuz N, Koltuksuz U, Demircan M (2002) Regional anesthesia is a good alternative to general anesthesia in pediatric surgery: experience in 1554 children. J Pediatr Surg 37(4):610–613. doi:10.1053/jpsu.2002.31619 CrossRefPubMed

17.

Suresh S, Long J, Birmingham PK, De Oliveira GS Jr. (2015) Are caudal blocks for pain control safe in children? An analysis of 18,650 caudal blocks from the Pediatric Regional Anesthesia Network (PRAN) database. Anesth Analg 120(1):151–156. doi:10.1213/ANE.0000000000000446 CrossRefPubMed

18.

Maitra S, Baidya DK, Pawar DK, Arora MK, Khanna P (2014) Epidural anesthesia and analgesia in the neonate: a review of current evidences. J Anesth 28(5):768–779. doi:10.1007/s00540-014-1796-8 CrossRefPubMed

19.

Bouchut JC, Dubois R, Foussat C, Moussa M, Diot N, Delafosse C, Claris O, Godard J (2001) Evaluation of caudal anaesthesia performed in conscious ex-premature infants for inguinal herniotomies. Paediatr Anaesth 11(1):55–58CrossRefPubMed

20.

Henderson K, Sethna NF, Berde CB (1993) Continuous caudal anesthesia for inguinal hernia repair in former preterm infants. J Clin Anesth 5(2):129–133CrossRefPubMed

21.

Peutrell JM, Hughes DG (1993) Epidural anaesthesia through caudal catheters for inguinal herniotomies in awake ex-premature babies. Anaesthesia 48(2):128–131CrossRefPubMed

22.

Pollock JE (2012) Intrathecal chloroprocaine—not yet “safe” by US FDA parameters. Int Anesthesiol Clin 50(1):93–100. doi:10.1097/AIA.0b013e31821bbb35 CrossRefPubMed

23.

Goldblum E, Atchabahian A (2013) The use of 2-chloroprocaine for spinal anaesthesia. Acta Anaesthesiol Scand 57(5):545–552. doi:10.1111/aas.12071 CrossRefPubMed

24.

Takenami T, Hiruma H, Kaneko H, Okamoto H, Kawakami T (2015) Effects of sodium bisulfite with or without procaine derivatives on axons of cultured mouse dorsal root ganglion neurons. Reg Anesth Pain Med 40(1):62–67. doi:10.1097/AAP.0000000000000195 CrossRefPubMed

25.

Wulf H, Hampl K, Steinfeldt T (2013) Speed spinal anesthesia revisited: new drugs and their clinical effects. Curr Opin Anaesthesiol 26(5):613–620. doi:10.1097/ACO.0b013e3283606b71 CrossRefPubMed

26.

Camponovo C, Wulf H, Ghisi D, Fanelli A, Riva T, Cristina D, Vassiliou T, Leschka K, Fanelli G (2014) Intrathecal 1% 2-chloroprocaine vs. 0.5% bupivacaine in ambulatory surgery: a prospective, observer-blinded, randomised, controlled trial. Acta Anaesthesiol Scand 58(5):560–566. doi:10.1111/aas.12291 CrossRefPubMed

27.

Welborn LG, Rice LJ, Hannallah RS, Broadman LM, Ruttimann UE, Fink R (1990) Postoperative apnea in former preterm infants: prospective comparison of spinal and general anesthesia. Anesthesiology 72(5):838–842CrossRefPubMed

28.

Gallagher TM, Crean PM (1989) Spinal anaesthesia in infants born prematurely. Anaesthesia 44(5):434–436CrossRefPubMed

29.

Krane EJ, Haberkern CM, Jacobson LE (1995) Postoperative apnea, bradycardia, and oxygen desaturation in formerly premature infants: prospective comparison of spinal and general anesthesia. Anesth Analg 80(1):7–13PubMed

30.

Zhang H, Du L, Du Z, Jiang H, Han D, Li Q (2015) Association between childhood exposure to single general anesthesia and neurodevelopment: a systematic review and meta-analysis of cohort study. J Anesth 29(5):749–757. doi:10.1007/s00540-015-2030-z CrossRefPubMed

31.

(2015) Consensus statement supplement: important questions remain on the effects of anesthetics on neurodevelopment in infants. http://Smarttots.org

32.

McEvoy CT, Aschner JL (2015) The natural history of bronchopulmonary dysplasia: the case for primary prevention. Clin Perinatol 42(4):911–931. doi:10.1016/j.clp.2015.08.014 CrossRefPubMedPubMedCentral

Title: Regional block via continuous caudal infusion as sole anesthetic for inguinal hernia repair in conscious neonates
Authors: Claudia M. Mueller
Tiffany J. Sinclair
Megan Stevens
Micaela Esquivel
Noah Gordon
Publication date: 01-03-2017
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Surgery International / Issue 3/2017
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-016-4027-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Regional block via continuous caudal infusion as sole anesthetic for inguinal hernia repair in conscious neonates

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2017

Comparison of in vivo immune responses following transplantation of vascularized and non-vascularized human dermo-epidermal skin substitutes

Laparoscopic versus open inguinal hernia repair in children ≤3: a randomized controlled trial

Urachal remnant presenting as a giant, cystic umbilical cord

Agreement and reproducibility of radiological signs in NEC using The Duke Abdominal Assessment Scale (DAAS)

Systematic review and need assessment of pediatric trauma outcome benchmarking tools for low-resource settings

Ultrasound-guided core needle biopsy in the diagnosis of neuroblastic tumors in children: a retrospective study on 83 cases