Comparison of caudal and retrolaminar blocks for postoperative analgesia in pediatric orchidopexy: a randomized controlled trial
Abstract
Background: Lower abdominal surgeries in children are associated with significant postoperative pain. While caudal block (CB) is widely used, ultrasound-guided truncal blocks such as retrolaminar block (RLB) may provide more targeted and prolonged analgesia.
Methods: In this double-blind, randomized controlled trial conducted at two tertiary hospitals (March 1-September 1, 2025), children aged 1-7 years (ASA I-II) scheduled for unilateral orchidopexy were randomized to RLB or CB. CB received 0.125% bupivacaine 1 mL/kg (max 20 mL); RLB received 0.25% bupivacaine 0.1 mL/kg, both under standardized general anesthesia with intraoperative IV paracetamol (10 mg/kg). FLACC scores were recorded at 30 min and 1, 2, 4, 6, 12, and 24 h. Rescue analgesia was IV paracetamol for FLACC 2-4 and IV tramadol for FLACC >4. Primary outcome was analgesic efficacy (FLACC at 12th hour). Secondary outcomes were time to first analgesic and total consumption within 24 h.
Results: Sixty-two patients were analyzed (N.=31 per group); baseline demographics did not differ. RLB yielded lower FLACC scores at 6 h (P=0.002), 12 h (P=0.007), and 24 h (P=0.018), with no difference at 30 min or 1 h (P>0.05). Time to first analgesic was longer with RLB (P<0.001), and total 24-h consumption was lower (P=0.001). Fewer patients required rescue analgesia with RLB (3/31) than CB (14/31). No major block-related complications occurred.
Conclusions: In pediatric orchidopexy, RLB provided superior and more durable…
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Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design.
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