Chedid Alexa, Masarwa Rawan, Muscogliati Rodrigo, Younes Khaled, Hassanieh Aya, Ezzedine Dima, Najem Leen, Safi Caren, Najem Zeina, Badhe Neel, Malek Krystel, Najjar Elie
Medical School, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, LBN.
Centre for Spinal Studies and Surgery, Queens Medical Centre, Nottingham University Hospitals National Health Service (NHS) Trust, Nottingham, GBR.
Cureus. 2025 Jul 9;17(7):e87584. doi: 10.7759/cureus.87584. eCollection 2025 Jul.
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.
竖脊肌平面阻滞（ESPB）和骶管硬膜外阻滞（CEB）是小儿外科手术镇痛中使用的两种区域麻醉技术。虽然CEB是一种成熟的方法，但ESPB因其具有延长镇痛时间的潜力而越来越受到关注。本系统评价和荟萃分析比较了ESPB和CEB在接受手术的小儿患者中的疗效和安全性。纳入了9项随机对照试验（n = 612）。主要结局是首次补救镇痛的时间，次要结局包括面部、腿部、活动、哭闹和安慰（FLACC）疼痛评分及不良事件。由于异质性高（I²> 90%），应用随机效应模型。与CEB相比，ESPB显著延长了首次补救镇痛的时间（标准均差（SMD）= 2.75，p < 0.0001）。术后24小时，ESPB的FLACC评分有所改善（SMD = 0.25，p = 0.03），而CEB在1小时时提供了更好的镇痛效果（SMD = 0.51，p = 0.04）。然而，与CEB组相比，ESPB组需要补救镇痛的患者比例相似（70%对60%，p = 0.62），尽管其作用持续时间更长，但仍对其临床益处提出了疑问。两种技术的并发症发生率均较低且相当。ESPB似乎是CEB的一种安全有效的替代方法，可提供延长的镇痛效果且安全性相似。然而，其延长持续时间的临床相关性受到补救镇痛需求相当的限制。未来需要大规模、标准化的研究来阐明其在小儿麻醉中的作用。
