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Background and Aims Pediatric literature on erector spinae plane block (ESPB) versus caudal epidural block is scanty. Hence, we aimed to compare the effect of ultrasound (USG) guided ESPB with USG guided CEB as a component of multimodal analgesia in pediatric patients undergoing abdominal surgery.

Methods This was a randomised, parallel group, outcome and assessor blind study. After institutional ethics committee approval and informed consent, fifty-two patients, aged 1 to 9 were randomized into two equal groups. ESPB group received unilateral or bilateral USG guided ESPB at T10 vertebral level with 0.5 ml/kg 0.25% bupivacaine per side. CEB group received ultrasound guided CEB with 1 ml/kg 0.25% bupivacaine. The primary outcome was the proportion of patients requiring rescue analgesia in the 1st 24 hours after surgery. Secondary outcomes were the duration of post-operative analgesia and FLACC scores.

Results Significantly more patients belonging to ESPB than CEB group required rescue analgesia (88.4% versus 42.3% respectively, p value <0.001) in the 1st 24 hours after surgery. The duration of analgesia was shorter in the ESPB group by 9.54 hours (95% CI: 4.51 to 14.57 hours, p=0.000). Though ESPB group patients had satisfactory FLACC scores, they were inferior to CEB group for the first 6 hours after surgery. No adverse effects were reported in both the groups.

Conclusions Both ESPB and CEB were safe and efficacious. CEB provided a longer duration and better quality of analgesia especially in the first 6 hours postoperatively. ESPB may be considered in pediatric patients undergoing abdominal surgery when CEB is contraindicated or difficult.