A Systematic Review and Meta-Analysis of Caudal Block as Compared to Noncaudal Regional Techniques for Inguinal Surgeries in Children

Abstract

This systematic review and meta-analysis were designed to compare the analgesic effectiveness and adverse effects with the use of caudal analgesia as compared to noncaudal regional analgesia techniques in children undergoing inguinal surgeries. MEDLINE, EMBASE, and CENTRAL (Cochrane) databases were searched for randomized control trials published in English language from 1946 up to 2013. Use of rescue analgesia and adverse effects were considered as primary and secondary outcomes, respectively. Outcomes were pooled using random effects model and reported as risk ratio (RR) with 95% CI. Out of 3240 hits and 24 reports for final selection, 17 were included in this review. Caudal analgesia was found to be better in both early (RR = 0.81 [0.66, 0.99], P = 0.04) and late (RR = 0.81 [0.69, 0.96], P = 0.01) periods, but with a significant risk of motor block and urinary retention. According to GRADE, the quality of evidence was moderate. Although potentially superior, caudal analgesia increases the chance of motor block and urinary retention. There are limited studies to demonstrate that the technical superiority using ultrasound translates into better clinical success with the inguinal nerve blocks.

Interventions for postoperative pain in children: An overview of systematic reviews

“…Seven SRs reported equal conclusive safety for epidural infusion, diclofenac intravenous vs ketamine added to opioid analgesia, bupivacaine, ketamine, paracetamol, and dexmedetomidine vs intravenous infusions of various opioid analgesics, oral suspension and suppository of diclofenac, only opioid, normal saline, no treatment, placebo, and midazolam . Negative conclusive statement for safety was reported in one SR for caudal analgesia vs noncaudal regional analgesia …”

“…Negative conclusive statement for safety was reported in one SR for caudal analgesia vs noncaudal regional analgesia . Safety was not mentioned or it was unclear in almost half of the analyzed SR conclusions.…”

“…19,24,25,30,[40][41][42] Negative conclusive statement for safety was reported in one SR for caudal analgesia vs noncaudal regional analgesia. 43 3.6 | Discrepancies in results of reviews that analyzed same interventions and comparators…”

Caudal Block with General Anesthesia for Outpatient Pediatric Surgery Procedures

“…As shown with in the Table 1, lower concentration of bupivacaine was given to the circumcision cases. Five criteria which already classified according to the OPS or The Wong-Baker faces pain score [1] crying, agitation, moves, posture and localization of place of pain were assessed postoperatively [1]Total score was between 0-10 and each criterion was given points between 0-2. Patients having OPS 4-6 were given oral or rectal 30-40mg/kg paracetamol.…”

“…Discomfort of the outpatient operation sometimes become more important task than operation itself because of unfamiliar and anxious parents and child. That is why proper pain control will be a very comfortable condition and less emotionally disturbing experience for patient and family, and also it reduces unnecessary hospital admissions [1].…”