Intervention Review

Regional (spinal, epidural, caudal) versus general anaesthesia in preterm infants undergoing inguinal herniorrhaphy in early infancy

  1. Paul D Craven1,*,
  2. Nadia Badawi2,
  3. David J Henderson-Smart3,
  4. Michele O'Brien4

Editorial Group: Cochrane Neonatal Group

Published Online: 21 JUL 2003

Assessed as up-to-date: 31 MAR 2003

DOI: 10.1002/14651858.CD003669

How to Cite

Craven PD, Badawi N, Henderson-Smart DJ, O'Brien M. Regional (spinal, epidural, caudal) versus general anaesthesia in preterm infants undergoing inguinal herniorrhaphy in early infancy. Cochrane Database of Systematic Reviews 2003, Issue 3. Art. No.: CD003669. DOI: 10.1002/14651858.CD003669.

Author Information

  1. 1

    John Hunter Hospital, Neonatal Intensive Care Unit, New Lambton, NSW, Australia

  2. 2

    The Children's Hospital at Westmead, Department of Neonatology, Westmead, NSW, Australia

  3. 3

    Queen Elizabeth II Research Institute, NSW Centre for Perinatal Health Services Research, Sydney, NSW, Australia

  4. 4

    The Children's Hospital at Westmead, Department of Anaesthetics, Westmead, NSW, Australia

*Paul D Craven, Neonatal Intensive Care Unit, John Hunter Hospital, Lookout Road, New Lambton, NSW, 2305, Australia. Paul.Craven@hnehealth.nsw.gov.au.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 21 JUL 2003

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

With improvements in neonatal intensive care, more premature infants are surviving the neonatal period. With this increase, more are presenting for surgery in early infancy. Of predominance in this period is the repair of inguinal herniae, appearing in 38% of infants whose birth weight is between 751g and 1000g. Most postoperative studies show that approximately 20% to 30% of otherwise healthy former preterm infants having inguinal herniorrhaphy under general anaesthesia have one or more apnoeas in the postoperative period. Regional anaesthesia might reduce postoperative apnoea in this population.

Objectives

To determine if regional anaesthesia, in preterm infants undergoing inguinal herniorrhaphy, reduces post-operative apnoea, bradycardia, and the use of assisted ventilation, in comparison to those infants undergoing inguinal herniorrhaphy with general anaesthesia.

Search methods

Randomised controlled trials were identified by searching MEDLINE (1966-Nov 2002), EMBASE (1982-Nov 2002), Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2002), reference lists of published trials and abstracts published in Pediatric Research.

Selection criteria

Randomised and quasi-randomised controlled trials of spinal versus general anaesthesia in preterm infants undergoing inguinal herniorrhaphy in early infancy.

Data collection and analysis

Data were extracted and the analyses performed independently by two reviewers. Authors of each eligible study were contacted for missing data. Studies were analysed for methodologic quality using the criteria of the Cochrane Neonatal Review Group. All data were analysed using RevMan 4.1. When possible meta-analysis was performed to calculate typical relative risk, typical risk difference, along with their 95% confidence intervals (CI).

Main results

Four small trials comparing spinal with general anaesthesia in the repair of inguinal hernia were identified. One trial was excluded due to inadequate information. There was no statistically significant difference in the proportions of infants having postoperative apnoea/bradycardia, typical RR 0.69 (0.40, 1.21) or postoperative oxygen desaturations, RR 0.91 (0.61, 1.37). If infants having preoperative sedatives were excluded, then the meta-analysis supported a reduction in postoperative apnoea in the spinal anaesthetic group, typical RR 0.39 (0.19, 0.81). There was a reduction of borderline statistical significance in the use of postoperative assisted ventilation with spinal anaesthesia. There was an increase of borderline statistical significance in anaesthetic placement failure when spinal anaesthesia was attempted.

Authors' conclusions

There is no reliable evidence from the trials reviewed concerning the effect of spinal as compared to general anaesthesia on the incidence of post-operative apnoea, bradycardia, or oxygen desaturation in ex-preterm infants undergoing herniorrhaphy. The estimates of effect in this review are based on a total population of only 108 patients or fewer.

A large well designed randomised controlled trial is needed to determine if spinal anaesthesia reduces post-operative apnoea in ex-preterm infants not pretreated with sedatives. Adequate blinding, follow up and intention to treat analysis are required.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Regional (spinal, epidural, caudal) versus general anaesthesia in preterm infants undergoing inguinal herniorrhaphy in early infancy

Not enough evidence to show whether regional anaesthesia is better than general anaesthetic for a preterm baby having surgery for inguinal hernia. Babies born preterm (before 37 weeks) often have serious health problems and sometimes need surgery. Inguinal hernia (where the intestine protrudes through the abdominal wall) is the commonest condition where surgery is needed. General anaesthetics for surgery can disrupt breathing and cause other complications in preterm babies. Regional anaesthetics including spinal block (injection) might avoid complications. Whether this improves outcomes for preterm babies having surgery has been unclear. The review found that there is not enough evidence from trials to show whether or not spinal block improves outcomes for a preterm baby having surgery for inguinal hernia.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

當早產嬰兒於早期接受腹股溝疝氣修補術時,接受區域麻醉(脊椎麻醉、硬膜外麻醉、尾端麻醉)與全身麻醉的差別

隨著重度新生兒照護的進步,更多的早產兒存活下來,因此,有更多的新生兒,如出生體重介於751公克和1000公克之間的嬰兒約有38% 在早期需要接受手術,尤其是需要接受腹股溝疝氣的修補。從目前的一些術後研究來說,發現之前都很健康的早產兒,在全身麻醉下接受腹股溝疝氣修補術,約有20 – 30% 在術後至少發生一次以上呼吸暫停的情形。而在這一個族群若接受區域麻醉似乎可以減少術後呼吸暫停的情形。

目標

評估需接受腹股溝疝氣修補術的早產兒中,使用區域麻醉或使用全身麻醉,哪一方式可以減少術後呼吸暫停、心搏過緩、或需使用輔助型呼吸器的比率。

搜尋策略

搜尋MEDLINE (1966Nov 2002), EMBASE (1982Nov 2002), Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2002), 已發表的試驗的參考書目表單及發表在Pediatric Research摘要作成的隨機對照試驗(Randomised controlled trials)。

選擇標準

選擇早產兒在早期接受腹股溝疝氣修補術時,比較全身和脊椎麻醉之隨機及類隨機對照試驗(Randomised and quasirandomised controlled trials)。

資料收集與分析

我們進行數據提取,並由兩個評審進行獨力的分析。每個有資格的研究若有缺失數據,會和作者進行接觸。使用Cochrane新生兒審查小組所提供的methodologic質量標準的研究分析。所有數據利用RevMan 4.1進行分析,並且計算其相對危險性,風險差異,以及他們的95 %信賴區間(CI)。

主要結論

有四個小試驗比較施行腹股溝疝氣修補術時脊椎與全身麻醉。一個試驗因資料不足被排除。另外三個試驗顯示出沒有統計學上顯著差異的有: 術後呼吸暫停、心搏過緩(其RR為0.69(0.40, 1.21))及術後氧氣濃度下降 ,其RR為0.91(0.61, 1.37)。如果將在手術前接受鎮定安眠的嬰兒排除在外,那麼, 分析數據後,發現施行脊髓麻醉組,可減少術後呼吸暫停的比率(typical RR: 0.39(0.19, 0.81)。然而在使用脊髓麻醉時,麻醉失敗的比率則有了接近統計學上意義的增加。

作者結論

從所審查的試驗中,早產兒進行疝氣修補術時,接受脊髓麻醉者和接受全身麻醉者相比,仍沒有可信賴的證據顯示是否可以降低術後產生呼吸暫停、心搏過緩及血氧下降的比率。這次回顧中研究的總人數只有108人甚至更少。因此,我們需要一個精心設計的大型隨機對照試驗,以確定在術前並無以鎮靜劑處理的早產兒,是否脊髓麻醉可以減少其術後的呼吸暫停。這需要充分雙盲,後續追蹤和治療分析的試驗。

翻譯人

本摘要由高雄醫學大學附設醫院吳佩玲翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

沒有足夠的證據來證明對於需要接受腹股溝疝氣修補術的早產嬰兒來說,是否接受區域麻醉優於全身麻醉。 早產兒(出生週數小於37週)往往有嚴重的健康問題,有時甚至需要手術治療。腹股溝疝氣(其中為小腸凸出通過腹壁)是最常見的需手術的情況。一般全身麻醉在早產嬰兒會阻斷呼吸和引起其他併發症。區域麻醉劑包括脊髓麻醉(注射)可能可避免併發症的發生。這對於是否可改善接受手術的早產嬰兒的預後結果並不清楚。 從我們的回顧發現,我們沒有足夠的證據證明是否脊髓麻醉可以改善接受腹股溝疝氣手術的早產嬰兒手術的預後。