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Background and Aims Circumcision may cause serious postoperative pain and patients often require additional analgesia. The caudal block (CB) is a commonly used regional anesthesia method to provide effective postoperative anealgesia in circumcision. The erector spina plane (ESP) block has been shown to provide effective postoperative analgesia when performed from the sacral level for urogenital surgery in pediatric patients. Aim of this study was to compare the analgesic efficacy of sacral ESP block and CB in pediatric circumsicion.

Methods Male patients aged 1-7 years in the ASA I-II group, who were scheduled for circumcision, were included in the study. A CB or ultrasound (US) guided SESP block was performed under general anesthesia before the operation. Postoperative pain was evaluated using the Face, Legs, Activity, Cry and Consolability (FLACC) scores. Analgesic requirements in the first 24 hours postoperatively, time of first analgesia need, and complications were recorded.

Results A total number of 150 patients (n=75 for CB, n=75 for SESP block) included in the study. Urinary retention was observed in 9 patients in the CB group. No side effects were observed in the SESP group. The 4th and 6th hours postoperative FLACC scores were lower in the SESP group. Analgesic consumptions in the first 24 hours postoperatively was significantly lower in the SESP group (p <0.001).

Conclusions SESP block provided more effective pain relief and prolonged analgesia compared to the CB and had no complications. US guided SESP block is a simple and safe regional anesthesia method for postoperative analgesia after circumcision.