Spinal Anesthesia in Preterm Infants for Surgical Procedures

Spinal anaesthesia has emerged as a valuable alternative to general anaesthesia for preterm infants undergoing infra-umbilical and lower limb surgeries. By delivering local anaesthetic into the cerebrospinal fluid at the lumbar level, this technique achieves rapid onset of sensory and motor blockade while preserving spontaneous respiration. In preterm infants, the avoidance of airway manipulation reduces the risk of postoperative apnoea and ventilatory support, minimises exposure to systemic anaesthetics and opioids, and shortens recovery times. Physiological considerations include the immature cardiovascular and respiratory systems, relative hypovolaemia and increased susceptibility to hypotension. Equipment refinements—smaller gauge needles, precise dosing regimens and bispectral monitoring—have improved safety margins. Spinal anaesthesia programmes now integrate multidisciplinary protocols for patient selection, periprocedural monitoring and postoperative observation. Globally, this approach offers cost-effective care in resource-limited settings and advances enhanced recovery pathways in tertiary centres. The accumulated evidence supports spinal blockade as an effective and versatile modality to reduce perioperative complications in this vulnerable population.

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Spinal Anesthesia in Preterm Infants for Surgical Procedures publication trend

The graph below shows the total number of articles in spinal anesthesia in preterm infants for surgical procedures across all publications each year (not limited to Nature Index journals).

Technical terms

Spinal anaesthesia: Regional block achieved by injection of local anaesthetic into the subarachnoid space, producing sensory and motor blockade below the puncture level.

Post-menstrual age (PMA): Gestational age at birth plus chronological age, used to assess maturation and anaesthetic risk in preterm infants.

Hyperbaric solution: Local anaesthetic formulated with added glucose to increase density, promoting predictable spread of block under gravity.

Levobupivacaine: The S-enantiomer of bupivacaine, offering a safer cardiotoxicity profile with similar anaesthetic potency.

Conversion to general anaesthesia: The need to abandon the spinal technique intraoperatively and secure the airway for general anaesthesia due to inadequate block or complications.

References

1. A Single Center's Experience With Spinal Anesthesia for Pediatric Patients Undergoing Surgical Procedures. Journal of Pediatric Surgery (2024).
2. Intrathecal levo-bupivacaine versus hyperbaric bupivacaine for inguinal hernia repairs in ex-preterm infants: A double blinded randomized prospective study. Egyptian Journal of Anaesthesia (2024).
3. Use of spinal anaesthesia in neonates and infants in Antananarivo, Madagascar: a retrospective descriptive study. BMC Research Notes (2020).
4. Improving Outcomes through Implementation of an Infant Spinal Anesthesia Program for Urologic Surgery Patients. Pediatric Quality and Safety (2023).