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Background and Aims To study the analgesic efficacy of sacral erector spinae plane (ESP) block as compared to caudal epidural in children undergoing lower limb and lower abdominal surgery under general anaesthesia (GA). Though caudal epidural provides excellent pain relief, it has certain limitations. Sacral ESP block is a recently described regional anaesthesia technique where a local anaesthetic (LA) agent is deposited above the sacral bone and below the erector spinae muscle.

Methods The study was an exploratory randomized controlled trial. A total of 50 children aged 1–9 years received either ultrasound-guided caudal or sacral ESP block after induction of GA. The outcomes measured were the duration of analgesia, pain scores (FLAC-Revised scale), total rescue analgesia required in 24 hrs.

Results A total of fifty children were included, 25 in each group. The demographic profile of children, type of surgery, duration of surgery, and anaesthesia were comparable. Time to the first requirement of analgesia (mean ± SD), were comparable in both the groups (873.6 ± 516.74 mins vs 828 ± 583.78 mins). The total duration of analgesia was also comparable in both the groups (965.8±473.70 min in Sacral ESP vs 1003.8 ±562.92 min in the caudal group, P value 0.789).

Conclusions Ultrasound-guided Sacral erector spinae plane block was found to be equivalent to caudal epidural block in terms of the total duration of analgesia, postoperative pain scores, postoperative analgesia requirement, and safety profile for children undergoing lower abdominal and lower limb surgeries under general anaesthesia