Caudal Epidural Anesthesia, Erector Spinae Plane Block, Pediatric
Conditions
Keywords
espb, caudal block, pediatric, erector spinae plane block
Brief summary
In routine pediatric surgical practice, lower abdominal surgeries are commonly performed. Inadequate control of postoperative pain can hinder functional recovery and may lead to negative behavioral changes as well as parental dissatisfaction. Regional anesthesia techniques are widely recommended for pain management in pediatric surgery, as they reduce the need for parenteral opioids and improve the effectiveness of postoperative pain control, patient comfort, and parental satisfaction. Various nerve block techniques have been developed to enhance postoperative analgesia and facilitate recovery in pediatric patients. However, there is still no consensus regarding the most effective regional anesthesia strategy for pediatric surgical procedures. Among regional anesthesia techniques used for pain management in children undergoing lower abdominal surgery, caudal block remains the most commonly applied method. The introduction of real-time ultrasound guidance has improved the reliability and safety of caudal blocks. Nevertheless, a major limitation of this technique is its relatively short duration of action following a single injection, even when long-acting local anesthetics or adjuvant agents are used. Consequently, several fascial plane blocks, such as the quadratus lumborum block, transversus abdominis plane block, and rectus sheath block, have been proposed as alternative approaches for postoperative analgesia in children. The erector spinae plane block is a regional anesthesia technique that has been applied at thoracic, lumbar, cervical, and sacral levels for both acute and chronic pain management. By providing blockade of both somatic and visceral pain pathways, it has demonstrated effective postoperative analgesic properties in a variety of thoracic and abdominal surgical procedures. The technique involves the injection of a local anesthetic into the interfascial plane between the erector spinae muscle and the transverse process, allowing longitudinal spread of the anesthetic across multiple spinal levels. With a growing body of evidence supporting its feasibility and effectiveness, the erector spinae plane block has gained increasing attention in pediatric anesthesia practice. The aim of this study is to evaluate and compare the analgesic efficacy and safety of ultrasound-guided erector spinae plane block and caudal block in pediatric patients undergoing unilateral lower abdominal surgery under general anesthesia. The primary objective is to compare postoperative pain levels between the two techniques using the FLACC score, which assesses facial expression, leg position, activity, crying, and consolability. Secondary objectives include the evaluation of intraoperative heart rate, blood pressure, and oxygen saturation, block application times, parental satisfaction, and the incidence of postoperative side effects.
Interventions
PROCEDURECaudal Block using Bupivacaine
A caudal block will be performed using 0.25 mg / ml / kg (maximum 20 ml) bupivacaine solution
ESP block will be performed using 0.25 mg / ml / kg (maximum 20 ml) bupivacaine solution
Sponsors
Ankara City Hospital Bilkent
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
1 Years to 8 Years
Healthy volunteers
Yes
Inclusion criteria
Children aged 1 to 8 years Scheduled for elective lower abdominal surgery American Society of Anesthesiologists (ASA) physical status I-II Written informed consent obtained from parent(s) or legal guardian(s)
Exclusion criteria
Presence of anatomical abnormalities Coagulation disorders Infection at the site of block application Severe cardiovascular, neurological, respiratory, or metabolic disease Known allergy to study medications Failed regional block Bilateral surgery or additional surgical procedures involving different surgical sites Refusal of parent(s) or legal guardian(s) to provide consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| FLACC pain score | 0, 30 minutes; 1, 2, 4, 8, 12, and 24 hours after surgery | Postoperative pain will be assessed using the FLACC scale. Unit of Measure: Score (0-10) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to first rescue analgesia | Up to 24 hours postoperatively | Time from the end of surgery to the first administration of rescue analgesic |
| Duration of Effective Analgesia | Up to 24 hours postoperatively | Time from block application to the first FLACC pain score ≥4 |
| Duration of Anesthesia | Intraoperative period | Time from anesthesia induction to awake extubation |
| Duration of Surgery | Intraoperative period | Time from skin incision to skin closure |
| Block Performance Time | Intraoperative period | Time from needle insertion to completion of block procedure |
| Intraoperative Heart Rate | 0, 15, 30, 45 minutes and 1 hour after inductio | Heart rate measured intraoperatively |
| Intraoperative Mean Arterial Pressure | 0, 15, 30, 45 minutes and 1 hour after induction | Mean arterial pressure measured intraoperatively |
| Intraoperative Oxygen Saturation | 0, 15, 30, 45 minutes and 1 hour after induction | Peripheral oxygen saturation measured intraoperatively |
| Postoperative Adverse Events | First 24 hours postoperatively | Incidence of postoperative adverse events including nausea, vomiting, nerve injury, or infection |
Outcome results
None listed