Erector spinae plane block as an alternative to caudal block in concurrent pediatric urologic and inguinal surgery: A double-blinded randomized controlled trial.

backgroundThe objective of this study is to evaluate and compare the analgesic effect of ultrasound (US)-guided a high-volume bilateral erector spinae plane (ESP) block with that of US-guided caudal block (CB) in these surgeries.

methodsThis prospective, randomized, double-blind study was conducted with 60 male patients, aged 1 to 7 years, who underwent lower abdominal surgery and circumcision concurrently. The patients were randomized into 2 groups: ESP and CB. US-guided ESP block at the L4 vertebral level was performed preoperatively using 1 mL/kg 0.125% bupivacaine (maximum of 20 mL), which was applied to patients in the ESP group. US-guided CB was performed preoperatively using 1 mL/kg 0.125% bupivacaine (max 20 mL), which was applied to patients in the CB group. Face, legs, activity, cry, and consolability scores for pain were recorded at 30 minutes and 1, 2, 4, 6, 12, and 24 hours postoperatively. Analgesic requirements, time to first analgesic requirement, and postoperative complications were also documented.

resultsThe 6- and 12-hours postoperative face, legs, activity, cry, and consolability scores were lower in the ESP group (P = .011, P = .021, respectively). The number of analgesic requirements in the first 24 hours postoperatively was significantly lower in the ESP group (P = .002). No postoperative complications were observed in either of the groups.

conclusionThis study shows that the ESP block provides effective and safe postoperative analgesia compared to the CB in pediatric patients undergoing circumcision and lower abdominal surgeries. Clinicians may consider the ESP block as another option for CB in such surgeries based on their clinical experience.