Kundal Raksha, Mahajan Ankita, Praveen Uppu, Shukla Medha, Kundal Vijay, Gupta Sunana
Department of Anaesthesia, Community Health Nursing, Vijaypur, Jammu, Jammu and Kashmir, India.
College of Nursing, All India Institute of Medical Sciences, Vijaypur, Jammu, Jammu and Kashmir, India.
Indian J Anaesth. 2025 Aug;69(8):759-769. doi: 10.4103/ija.ija_1249_24. Epub 2025 Jul 10.
Regional anaesthesia is a component of multimodal analgesia in paediatric surgery, providing effective pain relief. Traditional techniques, such as the caudal block (CB) and, more recently, fascial plane blocks, such as the erector spinae plane block (ESPB), have gained popularity. This systematic review and meta-analysis compares CB and ESPB in paediatric surgeries involving the lower abdomen or lower limbs. It aims to clarify mixed outcomes from recent trials regarding the variability in analgesic efficacy of both techniques for future practices.
This review, registered with the International Prospective Register of Systematic Reviews (PROSPERO), includes eight randomised controlled trials (RCTs) comparing postoperative analgesia between ESPB and CB in paediatric lower abdominal or lower limb surgeries. We searched the ScienceDirect, Google Scholar, Scopus, ProQuest, and PubMed databases. The meta-analysis assessed the proportion of patients requiring rescue analgesia and postoperative pain intensity. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidelines were applied to assess the quality of evidence.
Eight RCTs (575 patients) were included in the review. A meta-analysis of four RCTs (217 patients) showed no statistically significant difference (inconclusive) between ESPB and CB groups regarding the proportion of patients requiring rescue analgesia [Relative Risk (RR) =0.83, 95% confidence interval (CI): 0.29, 2.40, = 0.73], while six RCTs (360 patients) found lower pain intensity score (standardised mean difference = -0.37; 95% CI: -0.71, -0.02; = 0.04) in the ESPB group when compared to CB group. Both outcomes exhibited considerable heterogeneity (I² = 88% for rescue analgesia; I² = 62% for pain intensity), further emphasising the robustness of the findings.
We conclude that ESPB provides better postoperative analgesia than CB in children undergoing lower abdominal or lower limb surgeries. ESPB reduces postoperative pain intensity scores and analgesic requirements compared to CB.
区域麻醉是小儿外科多模式镇痛的组成部分，可有效缓解疼痛。传统技术，如骶管阻滞（CB），以及最近流行的筋膜平面阻滞，如竖脊肌平面阻滞（ESPB），都颇受关注。本系统评价和荟萃分析比较了在涉及下腹部或下肢的小儿手术中CB和ESPB的效果。其目的是澄清近期试验中关于这两种技术镇痛效果变异性的混合结果，以指导未来的实践。
本评价已在国际前瞻性系统评价注册库（PROSPERO）注册，纳入了八项随机对照试验（RCT），比较了ESPB和CB在小儿下腹部或下肢手术中的术后镇痛效果。我们检索了ScienceDirect、谷歌学术、Scopus、ProQuest和PubMed数据库。荟萃分析评估了需要补救性镇痛的患者比例和术后疼痛强度。应用推荐分级的评估、制定和评价（GRADE）指南来评估证据质量。
八项RCT（575例患者）纳入本评价。对四项RCT（217例患者）的荟萃分析显示，ESPB组和CB组在需要补救性镇痛的患者比例方面无统计学显著差异（结果不明确）[相对危险度（RR）=0.83，95%置信区间（CI）：0.29，2.40，P = 0.73]，而六项RCT（360例患者）发现，与CB组相比，ESPB组的疼痛强度评分更低（标准化均差=-0.37；95%CI：-0.71，-0.02；P = 0.04）。两种结果均表现出相当大的异质性（补救性镇痛的I² = 88%；疼痛强度的I² = 62%），进一步强调了研究结果的稳健性。
我们得出结论，在接受下腹部或下肢手术的儿童中，ESPB比CB提供更好的术后镇痛效果。与CB相比，ESPB降低了术后疼痛强度评分和镇痛需求。
