A systematic review and meta-analysis of caudal blockade versus alternative analgesic strategies for pediatric inguinal hernia repair.

BACKGROUND

The optimal analgesic strategy for pediatric inguinal hernia repair (IHR) remains undefined. We evaluated the available evidence comparing caudal blockade to alternative analgesic strategies in achieving post-operative analgesia.

METHODS

A systematic review of prospective studies comparing analgesic practices for open unilateral pediatric IHR was performed by searching Medline, Embase, and the Cochrane library from 1950-2011. Articles were critically appraised and included if adequate description of experimental (caudal) and control (nerve blockade or wound infiltration) groups were performed. Pain scores were standardized and evaluated 1 hour after procedure as was the need for rescue analgesia using REVMAN.

RESULTS

Three hundred and seventy articles were identified via our search strategy, thirteen of which were included for analysis. Articles identified were all single-institution, generally small (mean N=29 subjects/arm) and of poor quality (median Jadad score: 2). There was no significant difference in pain scores (-0.09, 95% CI: -0.32, 0.13, p=0.41) or the need for rescue analgesia (0.80, 95% CI: 0.56, 1.13, p=0.46).

CONCLUSION

There is no demonstrable difference in post-operative pain scores or rescue analgesia when comparing caudal blockade with alternative pain management strategies after pediatric IHR. This equipoise suggests that caudal blockade may be obviated for lower risk and less time-consuming maneuvers in patients barring supplementary indications for pain control.