Comparison of Caudal Block and Retrolaminar Block for Postoperative Analgesia in Concurrent Circumcision and Low Abdominal Surgery in Pediatric Patients: A Double-blind, Randomized Controlled Trial

This study is a double-blind, randomized controlled trial designed to compare the analgesic efficacy and safety of the retrolaminar block (RL) versus the caudal block (CB) in pediatric patients undergoing concurrent circumcision and lower abdominal surgery. The trial adheres to the ethical principles outlined in the Declaration of Helsinki and was conducted in the Anesthesiology and Reanimation department of a tertiary education and research hospital.

Study Population The study included pediatric patients aged 1 to 7 years who were classified as American Society of Anesthesiologists (ASA) physical status I or II. These patients were scheduled for elective, unilateral lower abdominal surgery (such as orchiopexy or hydrocelectomy) combined with circumcision. The inclusion criteria ensured the selection of otherwise healthy children with no significant comorbidities. Exclusion criteria included patients younger than 1 year or older than 7 years, those with neurological deficits, bleeding disorders, allergy to local anesthetics, infection at the injection site, congenital spinal anomalies, intellectual disabilities, psychiatric disorders, liver and/or kidney diseases, and those who declined to participate.

Randomization and Blinding Participants were randomly assigned to one of two groups (RL block or CB block) using a computer-generated randomization table. The randomization process was designed to ensure an equal distribution of patients across both groups. Both patients and the healthcare professionals involved in postoperative care were blinded to the type of block administered. To maintain blinding, both blocks were performed under sterile conditions, and identical transparent drapes were used to cover the injection sites. An anesthesiologist who was not involved in the block administration was responsible for data collection related to postoperative analgesic requirements and complications.

General Anesthesia Protocol All patients received 0.5 mg/kg of oral midazolam as premedication. In the operating room, standard monitoring was applied, and anesthesia was induced with intravenous (IV) propofol (2 mg/kg) and fentanyl (0.5 µg/kg). After the loss of the eyelash reflex, an appropriately sized laryngeal mask airway (LMA) was placed without the use of neuromuscular blocking agents. Anesthesia was maintained with sevoflurane (2%) in a mixture of 50% oxygen and air. Demographic data, including age, weight, type of surgery, duration of the procedure, and any complications, were recorded.

Regional Anesthesia Procedure Following the induction of general anesthesia and airway management, the patients were placed in the left lateral decubitus position for the regional block procedure. All blocks were performed by a single experienced operator skilled in pediatric ultrasound-guided regional anesthesia, using a 22-G, 50-mm echogenic needle. The ultrasound guidance was provided by a high-frequency (6.5-18 MHz) linear probe.