Efficacy of erector spinae plane block versus caudal block for postoperative analgesia in paediatric surgery: A systematic review and meta-analysis.

Background and aims: Regional anaesthesia is a component of multimodal analgesia in paediatric surgery, providing effective pain relief. Traditional techniques, such as the caudal block (CB) and, more recently, fascial plane blocks, such as the erector spinae plane block (ESPB), have gained popularity. This systematic review and meta-analysis compares CB and ESPB in paediatric surgeries involving the lower abdomen or lower limbs. It aims to clarify mixed outcomes from recent trials regarding the variability in analgesic efficacy of both techniques for future practices.

Methods: This review, registered with the International Prospective Register of Systematic Reviews (PROSPERO), includes eight randomised controlled trials (RCTs) comparing postoperative analgesia between ESPB and CB in paediatric lower abdominal or lower limb surgeries. We searched the ScienceDirect, Google Scholar, Scopus, ProQuest, and PubMed databases. The meta-analysis assessed the proportion of patients requiring rescue analgesia and postoperative pain intensity. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidelines were applied to assess the quality of evidence.

Result: Eight RCTs (575 patients) were included in the review. A meta-analysis of four RCTs (217 patients) showed no statistically significant difference (inconclusive) between ESPB and CB groups regarding the proportion of patients requiring rescue analgesia [Relative Risk (RR) =0.83, 95% confidence interval (CI): 0.29, 2.40, P = 0.73], while six RCTs (360 patients) found lower pain intensity score (standardised mean difference = -0.37; 95% CI: -0.71, -0.02; P = 0.04) in the ESPB group when compared to CB group. Both outcomes exhibited considerable heterogeneity (I² = 88% for rescue analgesia; I² = 62% for pain intensity), further emphasising the robustness of the findings.

Conclusion: We conclude that ESPB provides better postoperative analgesia than CB in children undergoing lower abdominal or lower limb surgeries. ESPB reduces postoperative pain intensity scores and analgesic requirements compared to CB.