1. 2022;25;E571-E580Ultrasound-guided Erector Spinae Muscle Block Versus Ultrasound-guided Caudal Block in Pediatric Patients Undergoing Lower Abdominal Surgeries
   Randomized Controlled Trial
   Amr Nady Abdelrazik, MD, Ibrahim Talaat Ibrahim, MD, Arwa Essam Farghaly, MBBCh, and Shadwa Rabea Mohamed, MD.

BACKGROUND: The erector spinae plane block is a new regional anesthetic technique that is gaining popularity in pediatric medicine.

OBJECTIVES: This study aimed to evaluate the safety and efficacy of ultrasound-guided erector spinae block and compare its analgesic effect with that of the ultrasound-guided caudal block in pediatric patients.

STUDY DESIGN: Prospective, randomized, double-blind, controlled study.

SETTING: Department of Anesthesia and Intensive Care, faculty of medicine, Minia University, Egypt.

METHODS: Sixty-three children scheduled for unilateral lower abdominal surgeries, under general anesthesia were randomly allocated into 3 parallel equal groups: Group I (erector spinae block [ESB] group) received ultrasound-guided an erector spinae muscle block in a dose of 0.4 mg/kg of 0.25% bupivacaine between the 10th transverse process and the erector spinae muscles. Group II (caudal block [CB] group) received an ultrasound-guided caudal block in a dose of 2.5 mg/kg of 0.25% bupivacaine. The last group, Group III (control [C] group), did not receive any regional block. Our primary outcome was to evaluate the quality of postoperative analgesia using the Face, Legs, Activity, Cry, Consolability (FLACC) Pain Scale; secondary outcomes were to assess the time to first analgesic request, total analgesic requests during the first 24 hours, and the occurrence of any side effects.

RESULTS: The early postoperative FLACC score was less in the ESB group than the CB group; both were lower than the control group. The erector spinae block had a longer duration of analgesia than the caudal block as the median (interquartile range [IQR]) ``of the duration of analgesia in the ESB group was 8 (8-12) hours while it was 6 (6-8) hours in group the CB group; both groups had a longer duration of analgesia compared to the C group 0.25 (0.17-4) hours. The total amount of analgesia was less in the ESB group than the CB group. The number of patients who needed rescue intravenous fentanyl analgesia was 14 patients in the C group while no patient needed intravenous fentanyl in the ESB and CB groups.

LIMITATIONS: Sensory evaluation of the patients was not done since the 2 blocks were done under general anesthesia but did not affect the outcome.

CONCLUSIONS: Ultrasound-guided erector spinae block was safe and effective in pediatric patients undergoing unilateral lower abdominal surgery as it provided a longer duration of analgesia and less analgesic requirement than caudal block and fewer side effects.

KEY WORDS: Ultrasound-guided, erector spinae, caudal, abdominal surgeries, analgesia, side effects, FLACC score, duration of analgesia