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

Erector spinae plane block (ESPB) and caudal epidural block (CEB) are two regional anaesthetic techniques used in paediatric surgical analgesia. While CEB is a well-established method, ESPB has gained increasing interest due to its potential for prolonged analgesia. This systematic review and meta-analysis compared the efficacy and safety of ESPB and CEB in paediatric patients undergoing surgery. Nine randomised controlled trials (n = 612) were included. The primary outcome was time to first rescue analgesia, with secondary outcomes including the Face, Legs, Activity, Cry, and Consolability (FLACC) pain scores and adverse events. A random-effects model was applied due to high heterogeneity (I² > 90%). ESPB significantly prolonged the time to first rescue analgesia compared to CB (standard mean difference (SMD) = 2.75, p < 0.0001). At 24 hours postoperatively, ESPB showed improved FLACC scores (SMD = 0.25, p = 0.03), while CEB provided better analgesia at one hour (SMD = 0.51, p = 0.04). However, a similar proportion of patients in the ESPB group required rescue analgesia when compared to the CEB group (70% vs. 60%, p = 0.62), raising questions about its clinical benefit despite the longer duration of effect. Both techniques demonstrated low and comparable complication rates. ESPB appears to be a safe and effective alternative to CEB, offering prolonged analgesia with similar safety outcomes. However, the clinical relevance of its extended duration is limited by the comparable need for rescue analgesia. Future large-scale, standardised studies are needed to clarify its role in paediatric anaesthesia.