Erector Spinae Plane Block Versus Caudal Block in Children: A Systematic Review and Meta-Analysis

Area of Science:

• Anesthesiology and Pain Management
• Pediatric Surgery
• Regional Anesthesia Techniques

Background:

• Erector spinae plane block (ESPB) and caudal epidural block (CEB) are regional anesthesia techniques for pediatric surgical pain.
• CEB is established, while ESPB is gaining interest for potentially longer-lasting pain relief.
• Comparative efficacy and safety data for these blocks in pediatric surgery are needed.

Purpose of the Study:

• To systematically review and meta-analyze the efficacy and safety of ESPB versus CEB in pediatric surgical patients.
• To compare time to first rescue analgesia and postoperative pain scores (FLACC) between the two techniques.
• To evaluate and compare adverse event rates associated with ESPB and CEB.

Main Methods:

• Systematic review and meta-analysis of nine randomized controlled trials involving 612 pediatric patients.
• Primary outcome: time to first rescue analgesia.
• Secondary outcomes: Face, Legs, Activity, Cry, and Consolability (FLACC) pain scores and adverse events; random-effects model due to high heterogeneity.

Main Results:

• ESPB significantly prolonged time to first rescue analgesia compared to CEB (SMD = 2.75, p < 0.0001).
• ESPB showed improved FLACC scores at 24 hours (SMD = 0.25, p = 0.03), while CEB provided better analgesia at 1 hour (SMD = 0.51, p = 0.04).
• Similar proportions of patients required rescue analgesia (70% ESPB vs. 60% CEB, p = 0.62) and complication rates were low and comparable.

Conclusions:

• ESPB is a safe and effective alternative to CEB for pediatric surgical analgesia, offering prolonged pain relief.
• The clinical benefit of ESPB's extended duration is tempered by comparable requirements for rescue analgesia.
• Further large-scale, standardized studies are necessary to fully define the role of ESPB in pediatric anesthesia.