Erector spinae plane block versus caudal epidural block in pediatric surgery: a systematic review and meta-analysis of randomized clinical trials
Background: Caudal Epidural Block (CEB) is a well-established regional anesthesia technique for abdominal and sub-abdominal pediatric surgeries. However, it has a short duration, often leading to additional analgesic administration. Erector Spinae Plane Block (ESPB), for instance, is an emerging tec...
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Elsevier
2025-07-01
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| Series: | Brazilian Journal of Anesthesiology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S0104001425000569 |
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| author | Barbara Bombassaro Masiero Deivyd Cavalcante Fatemeh Akbarpoor Capela António Dicazeco Pascoal Lubna Al-Sharif Fellipe Feijó Halfeld Lucas Cael Azevedo Ramos Bendaham Patricia Viana Jesslyn N. Haryianto Maria Luiza de Souza Rasia Mariana Copetti de Almeida Cunha Ana Djulia Tesche Júlia Caletti Roth de Oliveira Rafael Arsky Lombardi |
| author_facet | Barbara Bombassaro Masiero Deivyd Cavalcante Fatemeh Akbarpoor Capela António Dicazeco Pascoal Lubna Al-Sharif Fellipe Feijó Halfeld Lucas Cael Azevedo Ramos Bendaham Patricia Viana Jesslyn N. Haryianto Maria Luiza de Souza Rasia Mariana Copetti de Almeida Cunha Ana Djulia Tesche Júlia Caletti Roth de Oliveira Rafael Arsky Lombardi |
| author_sort | Barbara Bombassaro Masiero |
| collection | DOAJ |
| description | Background: Caudal Epidural Block (CEB) is a well-established regional anesthesia technique for abdominal and sub-abdominal pediatric surgeries. However, it has a short duration, often leading to additional analgesic administration. Erector Spinae Plane Block (ESPB), for instance, is an emerging technique that, like CEB, provides analgesic effect to a specific dermatome of the body during surgery and in the postoperative period. Therefore, we performed this systematic review with meta-analysis to compare both techniques. Methods: We searched PubMed, Embase and Cochrane Central for Randomized Controlled Trials (RCTs) comparing ESPB versus CEB in pediatric patients undergoing abdominal and sub-abdominal surgeries. The primary outcome was the time to first analgesic request. Secondary outcomes were I) FLACC score; II) Postoperative nausea and vomiting, and III) Urinary retention. Results: Nine randomized controlled trials encompassing 507 patients were included in this analysis (1‒9). The patients were predominantly male and under 10 years of age. There was an equal distribution between the two groups regarding the number of patients and patients’ baseline characteristics. The main results were: time to first analgesic request (MD = 3.71; 95% CI: -1.88–9.29; I2 = 99%; p = 0.19); FLACC scores at 2 hours (MD = 0.15; 95% CI: -0.30–0.59; I2 = 0%; p = 0.52); FLACC scores at 24 hours (MD = -0.17; 95% CI: -0.39–0.05; I2 = 41%; I2 = 41%; p = 0.13); urinary retention events (RR = 0.12; 95% CI: 0.02–0.94; I2 = 0%; p = 0.04); and Postoperative Nausea and Vomiting (PONV) which was null in both groups in three studies. However, it is important to clarify that some limitations were identified, such as significant heterogeneity in the following outcomes: time to first analgesic request and FLACC score at 24h, possibly due to different age groups, different types of surgeries, different background analgesia administration, and a relatively small sample size. As for the risk of bias, two studies were found to have some concerns in “bias due to deviations from intended interventions” (8,9). Conclusion: Our findings suggest that the administration of ESPB did not statistically differ from CEB regarding the time to first analgesic request. FLACC scores also did not show a statistically significant difference between groups. The ESPB group, however, experienced minor urinary retention events compared to the CEB group. Quality of evidence: According to the GRADE assessment, all outcomes evaluated in this study were classified as high-quality evidence. Quality assessment is detailed in Supplementary Table 1. |
| format | Article |
| id | doaj-art-eba8dfd89d254f61ae9ad1ab253b311f |
| institution | Kabale University |
| issn | 0104-0014 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brazilian Journal of Anesthesiology |
| spelling | doaj-art-eba8dfd89d254f61ae9ad1ab253b311f2025-08-20T03:28:36ZengElsevierBrazilian Journal of Anesthesiology0104-00142025-07-0175484464010.1016/j.bjane.2025.844640Erector spinae plane block versus caudal epidural block in pediatric surgery: a systematic review and meta-analysis of randomized clinical trialsBarbara Bombassaro Masiero0Deivyd Cavalcante1Fatemeh Akbarpoor2Capela António Dicazeco Pascoal3Lubna Al-Sharif4Fellipe Feijó Halfeld5Lucas Cael Azevedo Ramos Bendaham6Patricia Viana7Jesslyn N. Haryianto8Maria Luiza de Souza Rasia9Mariana Copetti de Almeida Cunha10Ana Djulia Tesche11Júlia Caletti Roth de Oliveira12Rafael Arsky Lombardi13Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil; Corresponding author.Universidade Federal do Maranhão, São Luís, MA, BrazilMohammed bin Rashid University of Medicine and Health Sciences, Dubai, UAEFaculdade de Medicina da Universidade Agostinho Neto, Luanda, AngolaAn-Najah National University, Nablus, PalestineUniversidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, BrazilUniversidade Federal de Roraima, Boa Vista, RR, BrazilUniversidade do Extremo Sul Catarinense, Criciúma, SC, BrazilPelita Harapan University, IndonesiaUniversidade de Caxias do Sul, Caxias do Sul, RS, BrazilPontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, BrazilPontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, BrazilPontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, BrazilUniversity of Nebraska, Lincoln, Kansas, United States of AmericaBackground: Caudal Epidural Block (CEB) is a well-established regional anesthesia technique for abdominal and sub-abdominal pediatric surgeries. However, it has a short duration, often leading to additional analgesic administration. Erector Spinae Plane Block (ESPB), for instance, is an emerging technique that, like CEB, provides analgesic effect to a specific dermatome of the body during surgery and in the postoperative period. Therefore, we performed this systematic review with meta-analysis to compare both techniques. Methods: We searched PubMed, Embase and Cochrane Central for Randomized Controlled Trials (RCTs) comparing ESPB versus CEB in pediatric patients undergoing abdominal and sub-abdominal surgeries. The primary outcome was the time to first analgesic request. Secondary outcomes were I) FLACC score; II) Postoperative nausea and vomiting, and III) Urinary retention. Results: Nine randomized controlled trials encompassing 507 patients were included in this analysis (1‒9). The patients were predominantly male and under 10 years of age. There was an equal distribution between the two groups regarding the number of patients and patients’ baseline characteristics. The main results were: time to first analgesic request (MD = 3.71; 95% CI: -1.88–9.29; I2 = 99%; p = 0.19); FLACC scores at 2 hours (MD = 0.15; 95% CI: -0.30–0.59; I2 = 0%; p = 0.52); FLACC scores at 24 hours (MD = -0.17; 95% CI: -0.39–0.05; I2 = 41%; I2 = 41%; p = 0.13); urinary retention events (RR = 0.12; 95% CI: 0.02–0.94; I2 = 0%; p = 0.04); and Postoperative Nausea and Vomiting (PONV) which was null in both groups in three studies. However, it is important to clarify that some limitations were identified, such as significant heterogeneity in the following outcomes: time to first analgesic request and FLACC score at 24h, possibly due to different age groups, different types of surgeries, different background analgesia administration, and a relatively small sample size. As for the risk of bias, two studies were found to have some concerns in “bias due to deviations from intended interventions” (8,9). Conclusion: Our findings suggest that the administration of ESPB did not statistically differ from CEB regarding the time to first analgesic request. FLACC scores also did not show a statistically significant difference between groups. The ESPB group, however, experienced minor urinary retention events compared to the CEB group. Quality of evidence: According to the GRADE assessment, all outcomes evaluated in this study were classified as high-quality evidence. Quality assessment is detailed in Supplementary Table 1.http://www.sciencedirect.com/science/article/pii/S0104001425000569AnalgesicsAnesthesia, caudalNerve blockPain measurementPediatricsPostoperative nausea and vomiting |
| spellingShingle | Barbara Bombassaro Masiero Deivyd Cavalcante Fatemeh Akbarpoor Capela António Dicazeco Pascoal Lubna Al-Sharif Fellipe Feijó Halfeld Lucas Cael Azevedo Ramos Bendaham Patricia Viana Jesslyn N. Haryianto Maria Luiza de Souza Rasia Mariana Copetti de Almeida Cunha Ana Djulia Tesche Júlia Caletti Roth de Oliveira Rafael Arsky Lombardi Erector spinae plane block versus caudal epidural block in pediatric surgery: a systematic review and meta-analysis of randomized clinical trials Brazilian Journal of Anesthesiology Analgesics Anesthesia, caudal Nerve block Pain measurement Pediatrics Postoperative nausea and vomiting |
| title | Erector spinae plane block versus caudal epidural block in pediatric surgery: a systematic review and meta-analysis of randomized clinical trials |
| title_full | Erector spinae plane block versus caudal epidural block in pediatric surgery: a systematic review and meta-analysis of randomized clinical trials |
| title_fullStr | Erector spinae plane block versus caudal epidural block in pediatric surgery: a systematic review and meta-analysis of randomized clinical trials |
| title_full_unstemmed | Erector spinae plane block versus caudal epidural block in pediatric surgery: a systematic review and meta-analysis of randomized clinical trials |
| title_short | Erector spinae plane block versus caudal epidural block in pediatric surgery: a systematic review and meta-analysis of randomized clinical trials |
| title_sort | erector spinae plane block versus caudal epidural block in pediatric surgery a systematic review and meta analysis of randomized clinical trials |
| topic | Analgesics Anesthesia, caudal Nerve block Pain measurement Pediatrics Postoperative nausea and vomiting |
| url | http://www.sciencedirect.com/science/article/pii/S0104001425000569 |
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