Awake caudal anesthesia method in inguinal hernia surgery in preterm infants

Objectives: This study aims to evaluate the safety and efficacy of awake caudal anesthesia in inguinal hernia repair surgery in preterm infants. Patients and methods: Between April 2024 and April 2025, a total of 15 preterm infants (10 males, 5 females; mean age: 10.60±3.90 weeks; range, 4 to 7 week) with a gestational age <37 weeks and a postconceptional age <46 weeks were retrospectively analyzed. The patients included in the study were those who underwent awake caudal anesthesia. The patients' demographic data, intra- and postoperative hemodynamic data, analgesia requirements, postoperative micturition time, complications, and discharge times were recorded. Results: Of the patients, 40% underwent bilateral surgery. Caudal anesthesia was technically successful in all patients. No patient developed bradycardia, apnea, or required general anesthesia during the operation. No respiratory depression, urinary retention, or neurological complications were observed in the postoperative period. All patients were discharged on the first postoperative day. The mean surgical duration was 29.4±6.37 min, and the mean time to first analgesia requirement was 3.33±0.48 h. Conclusion: Awake caudal anesthesia is a safe and effective regional anesthesia method for inguinal hernia repair in preterm infants. This method provides a significant advantage in low birth weight and small postconceptional age newborns by reducing the risks of respiratory and neurological complications associated with general anesthesia.