Caudal block vs. transversus abdominis plane block for pediatric surgery: a systematic review and meta-analysis

Abstract

BackgroundThe caudal block and transversus abdominis plane block (TAP) are commonly used in combination with general anesthesia for pediatric lower abdominal, inguinal, and genitourinary surgeries. There is limited data directly comparing the impact of these techniques on recovery. In this meta-analysis, we compare the duration of postoperative analgesia between these two techniques.ObjectiveThis review examined the duration of analgesia in pediatric patients (age 0–18 years) undergoing surgery who received caudal or TAP block after induction of general anesthesia. The primary outcome was duration of analgesia, defined as the time to first rescue analgesic dose. Secondary outcomes included number of rescue analgesic doses, acetaminophen usage within 24 h postoperatively, 24 h pain score area under the curve, and postoperative nausea and vomiting.Evidence reviewWe systematically searched Pubmed, Central, EMBASE, CINAHL, Google Scholar, Web of Science citation index, the US clinical trials register, and abstracts from prominent 2020–2022 anesthesia conferences for randomized controlled trials that compared these blocks and reported analgesia duration.FindingsTwelve RCTs inclusive of 825 patients were identified. TAP block was associated with longer analgesia duration (Mean difference = 1.76 h, 95% CI: 0.70–2.81, p = 0.001) and reduced doses of rescue analgesic within 24 h (Mean difference = 0.50 doses, 95% CI: 0.02–0.98, p = 0.04). No statistically significant differences were detected in other outcomes.ConclusionThis meta-analysis suggests that TAP block provides greater duration of analgesia than caudal block after pediatric surgeries. TAP block was also associated with fewer rescue analgesic doses in the first 24 h without increased pain scores.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=380876, identifier: CRD42022380876.

Peri-anal infiltration versus caudal block for multimodal analgesia in paediatric patients with Hirschsprung's disease undergoing transanal endorectal pull-through procedure: A randomised trial

“…[ 11 ] However, other studies reported that some peripheral blocks were superior to caudal blocks in other surgeries. [ 12 , 13 , 14 , 15 ] Regarding pull-through surgery in patients with HD, a previous study reported better postoperative analgesia and more stable intraoperative haemodynamics in the patients who underwent the surgery under combined general–caudal anaesthesia compared with those who underwent the surgery under only general anaesthesia. [ 16 ]…”

A Systematic Review and Meta-Analysis Comparing the Effectiveness of Transversus Abdominis Plane Block and Caudal Block for Relief of Postoperative Pain in Children Who Underwent Lower Abdominal Surgeries

“…However, the incidence rates of urinary retention and motor blocks are higher in the CB group [ 30 ]. Moreover, another meta-analysis suggested that TAPBs can provide a longer analgesia duration than CBs for pediatric inguinal and genitourinary surgeries [ 31 ]. Bryskin and colleagues reported that a TAPB was less effective than a CB for reducing the severity of bladder spasms when used in 45 children undergoing ureteral reimplantation surgery [ 11 ].…”