Review of Spinal Anesthesia for Pediatric Genitourinary Surgery

Purpose of Review In this review, we aim to provide insight into the current state of spinal anesthesia (SA) in pediatric urologic surgery while also acknowledging its historical use in pediatric general and orthopedic procedures. More specifically, we will highlight our own institutional protocol and techniques aimed at prolonging the effects of spinal anesthesia for cases with an anticipated duration lasting > 60 min. Recent Findings Recent studies have described success rates of nearly 90% for a wide range of operative times, with the maximum duration reported to be nearly 3 h. Most studies include a variety of penoscrotal cases under a single-shot spinal block of bupivacaine with or without adjunct medications, preoperatively and intraoperatively, to prolong effects. However, an approach has been described for more complex cases including ureteral reimplantation, ureterocele repair, megaureter repair, open pyeloplasty, and feminizing genitoplasty, combining spinal injection and caudal catheter placement. Summary Spinal anesthesia for pediatric urologic surgery requires close collaboration between anesthesiology and surgical teams. In general, spinal anesthesia has been used to safely perform urologic cases lasting < 60 min in duration; however, adjunctive medications have been used to prolong effects for longer, more complex cases with excellent outcomes.