Combined spinal and epidural anaesthesia for major abdominal surgery in infants

Purpose: Subarachnoid anaesthesia is becoming increasingly popular in neonates and infants. However, single dose spinal anaesthesia is of limited value for major abdominal surgery in infants due to its short duration of action and inability to provide analgesia in the post operative period. A new technique of combined spinal and epidural anaesthesia for major abdominal surgery in the infant is described. Methods: Data were gathered prospectively from 19 infants presenting for upper and lower abdominal surgery. Anaesthesia was induced with a subarachinoid injection of tetracaine. After the subarachnoid block was established, an epidural catheter was placed for further intraoperative and postoperative management. Data collected included age and weight of the patients, type and duration of the surgical procedure. Doses of local anaesthetics as well as the need for intraoperative and postoperative supplements were recorded. An illustrative case report is provided. Results: infants studied represented a wide range of weights (1520-7840 g). Spinal anaesthesia was successful in all 19 patients. A variety of extensive surgical procedures including small bowel resections and various genitourinary procedures were successfully performed. In 17 patients a functioning epidural catheter was in place postoperatively. In these patients effective analgesia was maintained with dilute solutions of epidural bupivacaine. Only three doses of narcotic were required for pain control. No patient required postoperative mechanical ventilation or tracheal intubation. Conclusion: Combined spinal and epidural anaesthesia is a potential option to general anaesthesia for major abdominal surgery in infants.