General Endotracheal vs. Non-Endotracheal Regional Anesthesia for Elective Inguinal Hernia Surgery in Very Preterm Neonates: A Single Institution Experience

Abstract Background Very pre-term infants (VP) at < 32wks post menstrual age PMA have a high incidence of bronchopulmonary dysplasia BPD. BPD places them at risk for pulmonary-related perioperative complications from general endotracheal anesthesia GE during elective inguinal hernia repair. Methods A retrospective cohort study was done to compare pulmonary-related perioperative risks between VP patients undergoing non-emergent inguinal hernia repair prior to NICU discharge under GE (n = 58) vs regional anesthesia RA (n = 37). Results Median PMA (RA 26 vs GE 27 wks), operative weight (RA 2.2 vs GE 2.27 Kg), % with BPD, medical and surgical comorbidities, number of concurrent procedures are similar between groups, except for sac laparoscopy (0% RA vs 36% GE). Procedural anesthesia time was RA 40 min vs GE 69 min, p < 0.001). GE (17%) vs RA (0%) remained intubated post op (p < 0.001). Oral feeding was fully tolerated in RA (97%) vs GE (72%, p = 0.002) by 48 h postop. The statistical differences hold after regression analysis controlling for sac laparoscopy and procedure time. No difference in intraoperative and post-op hernia complications is found. Conclusion RA is safe. RA is associated with early resumption of full feed, avoidance of prolonged mechanical intubation. We recommend a randomized controlled trial comparing the safety and efficacy of GE vs RA in VP infants undergoing elective NICU inguinal hernia repair. Retrospective Study - Level of Evidence: II