In premature infants, the incidence of inguinal hernia has been reported to be 14-30%. It is generally accepted that inguinal hernia should be repaired as soon as possible, as the incidence of incarceration is higher in infant than in children. However, the risk of life-threatening apnea after surgery is significant in this age group. Spinal anesthesia in premature infants offer a safe alternative to general anesthesia, especially if intubation should be avoid because of coexisting disease. We present a case of successful spinal anesthesia for inguinal herniorraphy in a premature female infant at a postconceptual age 44 + 6 weeks weighing 2,620 g with coexisting unilateral vocal cord paralysis to illustrate technical details and feasibility of this technique even in very low birth weight (birth weight < 1,500 g) infants.