Background: Several infants endure substantial pain after hip operations, which can have a negative impact on their health by causing restlessness, depression, and sleep disruption. According to recent research, 20% of infants experience prolonged postsurgical pain 6 to 12 months following major surgery, which is linked to functional impairment and a lower quality of life.Methods: 76 children, ranging from 1 year to 7 years old, scheduled for hip or proximal femur procedures were randomly assigned to receive either unilateral ultrasound guided erector spinae plane (ESPB) with 0.5 mL/Kg of bupivacaine 0.25% or caudal epidural anesthesia (CEA) with 0.5 mL/Kg of bupivacaine 0.25%. The primary outcome was the Face, Legs, Activity, Cry, and Consolability (FLACC) score 2 hours postoperatively. The secondary outcomes were pain scores every 15 minutes for the first hour and then at 6, 12, and 24 hours postoperatively, block failure rate, time taken to perform a successful block, , and the time for first rescue analgesia.
Results:The FLACC score 2 hours postoperatively wasn't superior in ESPB group compared to CEA group, in the contrary it was higher in the ESPB group compared to the CEA group at 15, and 30 minutes postoperative (p = 0.005, p = 0.004 respectively). The time to first rescue analgesia was prolonged in the CEA group (p value < 0.001), time to perform successful block was comparable between groups.Conclusions: ESPB hasn't shown a superior analgesic effect to CEA in pediatrics undergoing hip and proximal femur operations.