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Inguinal hernia repair in preterm neonates: is there evidence that spinal or general anaesthesia is the better option regarding intraoperative and postoperative complications? A systematic review and meta-analysis
  1. Katharina Dohms1,
  2. Marc Hein1,
  3. Rolf Rossaint1,
  4. Mark Coburn1,
  5. Christian Stoppe2,
  6. Constanze Barbara Ehret1,
  7. Tanja Berger3,
  8. Gereon Schälte1
  1. 1 Department of Anesthesiology, University Hospital RWTH Aachen, Medical Faculty, Aachen, Germany
  2. 2 Department of Intensive Care Medicine, University Hospital RWTH Aachen, Medical Faculty, Aachen, Germany
  3. 3 Department of Medical Statistics, Univeristy Hospital RWTH Aachen, Medical Faculty, Aachen, Germany
  1. Correspondence to Dr Gereon Schälte; gschaelte{at}ukaachen.de

Abstract

Objectives Whether spinal anaesthesia (SA) reduces intraoperative and postoperative complications compared with general anaesthesia (GA) was investigated.

Design The meta-analysis was structured based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Databases (PubMed, MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Web of Science) were searched, and four randomised controlled trials (RCTs) and two retrospective cohort studies were included. A random-effects model with pooled risk ratios and mean differences with 95% CIs were used. Statistical heterogeneity was evaluated using the I2 statistic. Quality assessment of the studies was performed by assessing the risk of bias according to the Cochrane and GRADE methodology.

Setting Publications from January 1990 to November 2018 were included.

Participants and interventions Our study selection captured information from studies focusing on neonates born before the 37th gestational week who were scheduled for an inguinal hernia repair operation under either SA or GA.

Primary and secondary outcome measures The primary outcome measures were apnoea, postoperative ventilation and method failure rates according to predefined eligibility criteria. The duration of surgery, desaturation events <80%, hospital stay duration and postoperative bradycardia were secondary outcomes.

Results We found significantly fewer events for the outcomes ‘any episode of apnoea’ and ‘mechanical ventilation postoperatively’ in the SA group. Bradycardias were significantly less common in the SA group. In total, 7.5% of the SA group were converted to GA. The duration of surgery was significantly shorter in the SA group. No significant differences were found in the outcome measures ‘postoperative oxygen supplementation’, ‘prolonged apnoea’, ‘postoperative oxygen desaturation <80%’ and ‘hospital stay’.

Conclusions We consider SA a convenient alternative for hernia repair in preterm infants, providing more safety regarding postoperative apnoea. To the best of our knowledge, this is the first meta-analysis to include studies exclusively comparing SA versus GA. More high-quality RCTs are needed.

Trial registration number CRD42016048683

  • apnoea
  • general anaesthesia
  • herniorrhaphy
  • neonates
  • spinal anaesthesia

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors GS and KD conceived of the study design of the review. GS and KD performed the literature search and eligibility assessment. KD performed the data extraction. GS and KD individually assessed the study quality and data analysis. TB reviewed the manuscript in terms of statistical methods analysis and structure. Clinical input and assistance with the discussion was given by GS, RR, CBE, MC, MH and CS. KD wrote the manuscript. All authors reviewed the manuscript and approved it.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository. Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.