Postoperative apnoea in ex-premature infants is inversely proportional to gestational age at birth and postmenstrual age (PMA). Spinal anaesthesia is an important technique in ex-premature infants as it reduces the risk of postoperative apnoea, provided intra-operative sedation is avoided. Recent studies have provided more data on recommended doses of local anaesthetics for infant spinal anaesthesia as well as adjuvants used to prolong the duration of surgical anaesthesia. Spinal anaesthesia is also used for surgical procedures other than inguinal hernia repair. There are a variety of reasons why awake regional is not the preferred technique for ex-premature infants undergoing lower abdominal surgery in many centres, and there is also controversy over the appropriate anaesthetic technique for outpatient surgery in infants <60 weeks PMA. A pragmatic decision analysis on the selection of anaesthetic techniques for inguinal hernia repair in infants is presented.