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Introduction: Caudal anesthesia is a standard procedure in pediatric anesthesia because of its excellent safety and success rate. Usually, it is administered after general anesthesia, but in selected neonatal populations, awake caudal anesthesia is a method of choice. Prematurely born, low birth weight neonates are more prone to complications from general anesthesia than term neonates, even after simple surgery. Among these complications, post-operative apnea is the most common. Caudal epidural anesthesia in awake neonates is a recognized technique that enables the avoidance of general anesthesia and the complications associated with it. In skilled hands, it is also theoretically easier to perform consistent caudal anesthesia than an awake subarachnoid block. In our case, we report a successful awake caudal anesthesia in an ex-premature baby in the emergency setting for incarcerated inguinal hernia repair. To our knowledge, this case report on this topic has yet to be published in Armenia. Conclusion: Neuraxial (spinal, epidural, caudal) awake anesthesia is the method of choice for lower abdominal surgery in preterm infants. Both spinal and caudal anesthesia are effective methods; awake caudal anesthesia is a method of choice because of the success rate and lower analgesic requirements in the post-operative period.