Analgesic efficacy of sacral erector spinae plane block in pediatric infraumbilical surgeries: a systematic review and meta-analysis of randomized controlled trials
Abstract
INTRODUCTION
Pediatric infraumbilical surgeries often lead to significant postoperative pain. Sacral erector spinae plane block (S-ESPB) is a novel ultrasound-guided technique that targets the sacral fascial plane and may provide extended analgesia with minimal motor block. This systematic review and meta-analysis evaluate the efficacy and safety of S-ESPB in pediatric patients compared to conventional regional techniques or no block at all.
EVIDENCE ACQUISITION
This review adhered to PRISMA 2020 guidelines and was registered with PROSPERO (CRD420251054390). A systematic search of PubMed, Scopus, Web of Science, and CENTRAL was conducted. Eligible studies included randomized controlled trials comparing S-ESPB to caudal blocks, penile blocks, ring blocks, or no block in pediatric patients. The primary outcome was time to first request for rescue analgesia. Secondary outcomes encompassed early postoperative (Face, Legs, Activity, Cry, Consolability) FLACC scores, 24-hour paracetamol consumption, the need for rescue analgesia, and adverse events. The risk of bias was evaluated using RoB 2, and the evidence's certainty was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE).
EVIDENCE SYNTHESIS
Six trials involving 437 participants were included in the review. S-ESPB significantly prolonged the time to first request for rescue analgesia compared to caudal, ring, penile, or no block (SMD: 4.02; 95% CI: 0.92-7.11; P=0.011). Subgroup analyses…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 437 participants or records.
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