Comparison Between Ultrasound-guided Caudal Analgesia versus Peripheral Nerve Blocks for Lower Limb Surgeries in Pediatrics: A Randomized Controlled Prospective Study

Abstract

Background and Aim: Ultrasound (US) guided regional analgesia is a safe and effective method in providing perioperative analgesia in pediatrics with a high success rate rapid onset and fewer side effects. The aim of this study was to compare the efficacy of US-guided caudal block versus US-guided peripheral nerve blocks (femoral and sciatic nerve blocks) in providing perioperative analgesia in pediatrics undergoing unilateral lower limb surgery. Methods: Children aged 1-12 years scheduled for unilateral lower limb surgery during the period from January 2020 to December 2021 were randomly allocated into two groups. Group C where pediatrics received US-guided caudal block, while in group P, pediatrics received US-guided femoral and sciatic nerve blocks after the induction of general anesthesia (GA). The primary aim was to compare the postoperative pain (evaluated by the COMFORT pain score) between the two groups. Secondary aims were to compare perioperative opioids used parents' satisfaction and occurrence of side effects. Results: Pediatrics who underwent unilateral lower limb surgeries were allocated into two groups (group C and group P). There was no significant difference between patients' baseline characteristics and the postoperative pain score at 2, 4, 16, and 20 h.' However there was a statistical significance at 6, 8, 12, and 24 h postoperatively, frequency of analgesia as well as the total postoperative dose of opiates (nalbuphine). Time to first analgesic (nalbuphine) requirement was significantly less in group C with a mean of (9.6±2.9 h) than in group P with a mean of (15.1±3.5 h). Parents of children in group P were more satisfied than those in group C with no recorded complications for both techniques. Conclusion: US-guided lower limb peripheral nerve block is a simple and safe method to provide adequate and more prolonged analgesia compared to US-guided caudal block for lower limb surgeries in pediatrics.

Ultrasound-Guided Sciatic Nerve Block vs. Caudal Analgesia in Cerebral Palsy Undergoing Lower Limb Surgeries

“…The primary outcome of this study was the time to the first postoperative analgesia requirement. The sample size was calculated by PASS 15 program, based on the results of a study by Mahrous et al (15) in which the duration to the first postoperative opioid demand was significantly shorter in the caudal group compared to PNB group, with mean and standard deviation (SD) of 9.6 ± 2.9 vs. 15.1 ± 3.5; considering a 20% dropout rate, the calculated sample size of 15 patients per each study group achieved 97% power to reject the null hypothesis of equal means when the difference between population means is µ1-µ2 = 9.6-15.1 = -5.5, with SD of 2.9 for 1st group and 3.5 for the 2nd group and a significance level of 0.05, utilizing the 2-samples unequal variance z-test.…”