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Background and Aims Awake regional anaesthesia (RA) is a potentially safer alternative to general anaesthesia (GA) for neonatal abdominal surgeries. Benefits include lower incidence of postoperative apnoea, neuroapoptosis and neurocognitive decline. We conducted a retrospective audit of the neonates undergoing surgeries under awake spinal anaesthesia, determining the efficacy and safety profile of the anaesthesia technique in the perioperative period.

Methods It was a retrospective observational study of neonates undergoing abdominal surgeries under awake spinal anaesthesia over a 6 months period. 17 neonates were studied and their data analysed. Primary outcomes measured were the duration and adequacy of the motor blockade, the intraoperative hemodynamic stability and postoperative apnoea. Secondary outcomes measured were attempts needed for successful spinal tap, need of sedatives, surgeon satisfaction and postoperative complications, if any.

Results Spinal anaesthesia was adequate for completion of surgeries in 76% of the patients. A bloody tap was encountered in 17% of the patients needing conversion to general anaesthesia. Haemodynamic stability was maintained in 70% of patients with brief periods of hypotension needing support in 5 patients. None of the children developed postoperative apnoea. Additional sedatives were needed in 23% of patients. Only one child desaturated till 88% intraoperatively needing oxygen supplementation. Surgeon satisfaction measured on a Likert Scale was very good in 70%.

Conclusions Spinal anaesthesia seems effective in short duration abdominal surgeries in preterm as well as full term neonates with good perioperative stability. The success rate may improve in the hands of skilled paediatric anaesthesiologists and dedicated spinal needles.