Sacral ESPB better than caudal block for hypospadias repair among children: Study

Caudal block is the preferred choice for postoperative pain relief in children undergoing hypospadias repair. Recent study compares the use of sacral erector spinae plane block (ESPB) and caudal block for postoperative analgesia in pediatric patients undergoing hypospadias repair. The primary objective of the study was to compare the time to first rescue analgesia, and the secondary outcomes included intraoperative hemodynamic parameters, fentanyl consumption, postoperative FLACC score, and 24-hour analgesic consumption. The study involved 50 children between 2-7 years of age, with Group I receiving sacral ESPB and Group II receiving caudal block.

Study Results

The results of the study showed that the mean time to first rescue analgesia was significantly longer in the sacral ESPB group compared to the caudal block group. Additionally, the FLACC score was significantly higher at various time points in the caudal block group, indicating higher postoperative pain. Moreover, the mean postoperative analgesic consumption was significantly lower in the sacral ESPB group compared to the caudal block group. These findings suggest that sacral ESPB is associated with better postoperative analgesia outcomes compared to caudal block in pediatric patients undergoing hypospadias repair.

Methodology and Rationale

The study also provides a detailed description of the methodology, including the use of ultrasound guidance for administering the blocks, randomization process, and data collection procedures. The authors discussed the rationale for comparing sacral ESPB and caudal block, highlighting the potential benefits of sacral ESPB in providing effective and long-lasting postoperative analgesia. The paper acknowledges the limitations of the study, such as its single-center nature, small sample size, and the need for long-term follow-up to assess outcomes beyond 24 hours postoperatively.

The article also discusses previous studies on sacral ESPB and caudal block, providing a comprehensive review of the existing literature on the topic. Additionally, the paper outlines the implications of the study's findings for clinical practice, emphasizing the potential superiority of sacral ESPB for postoperative pain management in pediatric patients undergoing hypospadias repair. The authors also highlight the need for further research in this area to validate the results and address the limitations of the current study.

Overall, the study provides valuable insights into the comparative effectiveness of sacral ESPB and caudal block for postoperative analgesia in pediatric patients, contributing to the ongoing research on pain management strategies in pediatric surgery. The detailed methodology, comprehensive analysis of outcomes, and critical discussion of the results make this study a significant contribution to the field of pediatric anesthesia and pain management.

Key Points -

1. The study aimed to compare the effectiveness of sacral erector spinae plane block (ESPB) and caudal block for postoperative analgesia in pediatric patients undergoing hypospadias repair. The primary outcome was the time to first rescue analgesia, with secondary outcomes including intraoperative hemodynamic parameters, fentanyl consumption, postoperative FLACC score, and 24-hour analgesic consumption. The study involved 50 children aged 2-7, with Group I receiving sacral ESPB and Group II receiving caudal block.

2. Findings revealed that sacral ESPB was associated with a significantly longer mean time to first rescue analgesia compared to the caudal block group. Additionally, the caudal block group exhibited higher postoperative pain as indicated by significantly higher FLACC scores at various time points. Moreover, postoperative analgesic consumption was significantly lower in the sacral ESPB group compared to the caudal block group, suggesting better postoperative analgesia outcomes with sacral ESPB for pediatric patients undergoing hypospadias repair.

3. The study employed ultrasound guidance for administering the blocks, a randomized process, and detailed data collection procedures. The rationale for comparing sacral ESPB and caudal block was discussed, highlighting the potential benefits of sacral ESPB in providing effective and long-lasting postoperative analgesia. The study acknowledged limitations such as its single-center nature, small sample size, and the need for long-term follow-up for outcomes beyond 24 hours postoperatively.

4. The article provided a comprehensive review of the existing literature on sacral ESPB and caudal block, discussed the implications of the study's findings for clinical practice, and emphasized the need for further research in the area to validate the results and address the study's limitations.

5. The study contributes valuable insights into the comparative effectiveness of sacral ESPB and caudal block for postoperative analgesia in pediatric patients undergoing hypospadias repair. The detailed methodology, comprehensive analysis of outcomes, and critical discussion of the results make this study a significant contribution to the field of pediatric anesthesia and pain management.

6. The study is significant in contributing to ongoing research on pain management strategies in pediatric surgery. Its findings suggest the potential superiority of sacral ESPB for postoperative pain management in pediatric patients undergoing hypospadias repair, highlighting the need for further validation and addressing study limitations.

Reference –

Bansal T, Kumar P, Kadian Y, Jain M, Singh AK, Lal J, et al. Comparison of ultrasound‑guided sacral erector spinae plane block and caudal epidural block for analgesia in paediatric patients undergoing hypospadias repair: A double‑blind, randomised controlled trial. Indian J Anaesth 2024;68:725‑30.