Ultrasound-guided lumbar erector spinae plane block versus caudal block for postoperative analgesia in pediatric hip and proximal femur surgery: a randomized controlled study

Abstract

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.

Continuous lumbar erector spinae plane block as an alternative to epidural analgesia in pain treatment in patients undergoing hip replacement surgery – a prospective pilot study

“…In this randomized controlled trial (RCT), the authors noted lower pain severity and the time to first rescue analgesia in patients following caudal block. In contrast to our study, Elshazly et al [13] used a single-injection technique without leaving a catheter for continuous postoperative infusion.…”

“…To our knowledge, no previous research has directly investigated the lumbar ESPB and epidural analgesia. However, Elshazly et al [13] compared the ESPB to caudal block in children undergoing hip and proximal femur surgery. In this randomized controlled trial (RCT), the authors noted lower pain severity and the time to first rescue analgesia in patients following caudal block.…”

The analgesic efficacy of ultrasound-guided erector spinae plane block versus ultrasound-guided caudal epidural block for abdominal surgery in pediatric patients – A patient and assessor-blind, randomized controlled study

“…On the other hand, Elshazly et al . [ 18 ] reported single-shot ESPB to be inferior to CEB for femur and hip surgeries. We could identify only two studies (either on children or adults) on neuraxial techniques versus ESPB for inguinal or abdominal surgeries.…”