Sacral Erector Spinae Block Versus Ultrasound-guided Caudal Block in Children Undergoing Hypospadias Surgery: A Randomized Controlled Multicentric Trial
Gözen Öksüz, Can Aksu, Yavuz Gürkan, Mahmut Arslan, Alparslan Kuş, Coşkun Çiftçi, Ali Erdal Karakaya, Hafize Öksüz
ABSTRACT
Backgrounds and Objectives
Caudal block is the most commonly used analgesic method for hypospadias surgery, but there are potential side effects, and the duration of the block is relatively short. Aksu and Gurkan1 reported that the Sacral erector spinae block (SESB) successfully provided postoperative analgesia in a pediatric patient who underwent hypospadias surgery. This double-blind prospective randomized multicentric trial was designed to compare the postoperative analgesic efficacies of SESB and caudal block using pain scores and analgesic consumption during hypospadias surgery in children.
Materials and Methods
After receiving approval from the Ethics Committee and registered at Clinicaltrials.gov ( NCT04106687), 46 patients underwent hypospadias surgery received SESB or caudal block group randomly. Demographic data, analgesic requirement, Face, Legs, Activity, Cry, Consolability (FLACC) scores at 30 minutes, 1, 2, 4, 6, 12, and 24 hours, parent satisfaction scores, and complications were recorded.
Results
Forty-four patients were included in this study after excluding two patients.(Figure 1) Demographic data were similar in both groups (p>0.05).(Table1)The number of analgesic consumptions during the first 24 hours postoperatively was significantly lower in the SESB group. (Figure 2) The 4-, 6-, 12- and 24-hour postoperative FLACC scores were lower in the SESB group (p = 0.012, p = 0.024, p < 0.001, and p < 0.001, respectively); the 30-min, 1-, and 2-hour FLACC scores of both groups were not significantly different (p = 0.327, 0.522, 0.387, respectively).(Table2) Parent satisfaction scores were higher in the SESB group (p = 0.034) (Figure 3).
Discussion
To our knowledge, this is the first randomized, prospective study comparing SESB and caudal blocks for postoperative pain relief after hypospadias surgery in children. This study showed that the SESB block provided lower pain scores and analgesic consumption than the caudal block.
Conclusion
SESB may be a good alternative analgesic method in pediatric patients undergoing hypospadias surgery, and this study showed that SESB provided longer and more effective postoperative analgesia than the caudal block.
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