EFFICACY OF ERECTOR SPINAE PLANE BLOCK VS CAUDAL EPIDURAL BLOCK FOR PERIOPERATIVE ANALGESIA IN CHILDREN UNDERGOING OPEN PYELOPLASTY: A RANDOMIZED CONTROLLED STUDY

With the increasing use of ultrasound guided interventions, the erector spinae plane block (ESPB) is slowly gaining popularity for perioperative analgesia in paediatric surgeries. ESPB is a novel interfascial plane block in which a local anaesthetic agent is injected under USG guidance between the Erector spinae muscle and the underlying vertebral transverse processes. In comparison to the popular central neuraxial caudal epidural block (CEB), the ESPB is superficial, and there are no major neurovascular structures in close vicinity of the fascial plane. Applying the ESPB post induction in a surgery like pyeloplasty under GA will thus reduce the chances of neurovascular injury and also decrease the requirements of systemic and opioid analgesics. This will reduce the incidence of respiratory depression, confusion, nausea, vomiting, drowsiness, and prolonged hospital stay etc. seen with opioid use. The proposed randomized controlled study aims to compare the perioperative analgesic efficacy of ESPB vs. CEB in children with PUJ obstruction undergoing pyeloplasty. The study will be carried out among 60 subjects divided into two groups. FLACC score will be measured postoperatively at subsequent time intervals namely at 0 min, 30 min, 1h, 2 h, 3hr, 6 h, 12 h, 18 h and 24 h. Following induction of anaesthesia, Group ESPB will receive an ultrasound guided erector spinae plane block and Group CEB will receive a caudal epidural block. We hypothesize that administration of an ultrasound guided single shot ESPB post induction in an open pyeloplasty operation will be more efficacious for perioperative analgesia and reduce the need for systemic opioids, as compared to a single shot CEB.