Ultrasound-Guided sacral erector spinae plane block versus caudal epidural block for postoperative analgesia in children undergoinghypospadias surgery: Randomized controlled study

Hypospadias occurs in 1 in 200 new born males and its correction is one of the most common Urological surgeries performed in children [1]. Various methods and medications that have Been tried to provide postoperative pain relief in the paediatric population can be associated Side effects. Use of opioid in paediatrics shows somnolence, vomiting and also respiratory Depression as an alarming side effect [2].Regional analgesia utilized for this penile reconstructive surgery is typically either a caudal Or dorsal penile nerve block. Caudal blocks are the most commonly performed blocks in Children undergoing pelvic genitourinary surgery and are frequently performed for Hypospadias surgery [3].Caudal injection through the sacral hiatus is easy to perform. For most of the year’s caudal Block is considered to be effective in further prolonging postoperative analgesia. However,Variations in sacral anatomy, the potential for coagulopathy and the possible infection risks Contribute to the complexity of application and success of the block. Caudal block may also Lead to some complications like motor block, urinary retention, block failure, blood Aspiration, and intra- vascular injection. [2]Nowadays, the use of ultrasound (US)-guided nerve block resulted in the revolutionary Change in the field of regional anaesthesia in paediatrics. Many truncal blocks are used for Both upper and lower abdominal surgeries with a high success rate [4]. Nerve blockade has Been shown to be as effective as caudal block for infra umbilical surgeries. Recent literature Suggests that, as an alternative method, peripheral nerve blocks have longer analgesia Duration and fewer adverse effects than neuraxial blocks [5,6]Erector spinae plane block (ESPB) was first described by Foreroin 2016 as an interfascial

plane block which was 1st performed at the upper thoracic levels for the treatment of thoracic neuropathic pain; eventually it was used in lower thoracic and lumbar levels.ESP block carries promise as a simpler and safer alternative to caudal block. The efficacy of this technique for the management of acute and chronic pain in the thoracic region is reported to be effective [7,8]. Case reports on sacral ESP block states that sacral erector spinae plane block provides surgical anaesthesia in ambulatory anorectal surgery [18].ESP block when used in paediatric patients presenting for hip surgery improved the postoperative analgesia. Therefore, we consider that in sacral region, it may have the same anatomical considerations to get good result.