Ultrasound-guided sacral multifidus plane block versus caudal epidural block for postoperative analgesia in pediatric hypospadias surgery: A randomized double-blind controlled trial
Abstract
Introduction: Hypospadias repair is associated with moderate to severe postoperative pain in children. Caudal epidural block is traditionally considered the standard regional anesthetic technique for sub-umbilical pediatric surgeries; however, its duration of analgesia and potential adverse effects may be limited. The sacral multifidus plane block (SMPB) is a novel ultrasound-guided fascial plane technique that may provide prolonged analgesia with fewer complications. The aim of this study is to compare the analgesic efficacy and safety of ultrasound-guided sacral multifidus plane block versus caudal epidural block in children undergoing hypospadias repair.
Materials and methods: This prospective, randomized, double-blind controlled trial included 30 children aged 1-5 years (ASA I-II) scheduled for hypospadias repair. Patients were randomly allocated to receive either SMPB (n = 15) or caudal block (n = 15), using 1 mL/kg of 0.25% bupivacaine. The primary outcome was time to first rescue analgesia. Secondary outcomes included postoperative FLACC pain scores, total rescue analgesic consumption, intraoperative fentanyl requirements, hemodynamic variables, and block-related complications. Pain was assessed for 24 hours postoperatively.
Results: Demographic and intraoperative characteristics were comparable between groups. Time to first rescue analgesia was significantly longer in the SMPB group compared with the caudal group (14.8 ± 3.6 vs 9.3 ± 4.2 hours, p = 0.004). FLACC…
How strong is the evidence?
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. Reported size: 30 participants or records.
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