Extending indications for spinal anesthesia.

Because of its simplicity, spinal anesthesia is an easy regional technique to use in the pediatric age group. Because ambulation is not usually an issue in the infant, this technique can be used to provide postoperative analgesia for outpatient lower extremity and perineal operations. The rate of postdural puncture headaches is low in young pat ien ts -be ing reported as 1:60 in one series (1). Spinal anesthesia is safer in avoiding respiratory depression in neonates who are at risk because of prematurity (2). In fact, spinal anesthesia at higher levels has been used for repair of patent ductus arteriosus in a series of 15 neonates (3). Although such extreme applications are rare, it is common to use spinal anesthesia for everyday outpatient pediatric surgery (1), where lidocaine and tetracaine can produce 60 to 90 minutes of surgical anesthesia respectfully in infants undergoing surgery below the diaphragm (4).