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Caudal analgesia versus abdominal wall blocks for pediatric genitourinary surgery: systematic review and meta-analysis
  1. Neel Desai1,2,
  2. Edmund Chan1,
  3. Kariem El-Boghdadly1,2 and
  4. Eric Albrecht3
  1. 1Department of Anaesthesia, Guy's and Saint Thomas' NHS Foundation Trust, London, United Kingdom
  2. 2King's College London, London, United Kingdom
  3. 3Department of Anaesthesia, University of Lausanne, Lausanne, Vaud, Switzerland
  1. Correspondence to Dr Neel Desai, Department of Anaesthesia, Guy's and Saint Thomas' NHS Foundation Trust, London SE1 9RS, United Kingdom; Neel.Desai{at}gstt.nhs.uk

Abstract

Background Caudal block is a well-established technique for providing perioperative analgesia in pediatric genitourinary surgery, but abdominal wall blocks such as ilioinguinal–iliohypogastric (II-IH) and transversus abdominis plane (TAP) block are increasingly being used.

Methods Our protocol for this meta-analysis was registered on PROSPERO (CRD42020163497). Central, CINAHL, Embase, Global Health, LILACS, MEDLINE, Scopus and Web of Science were searched from inception to 11 December 2019 for randomized controlled trials that included pediatric patients having genitourinary surgery with II-IH or TAP block as the intervention and caudal analgesia as the comparator. For continuous and dichotomous outcomes, respectively, we calculated the mean difference using the inverse-variance method and the risk ratio with the Mantel-Haenzel method.

Results In all, 23 trials with 1399 patients were included. II-IH and TAP block were similar to caudal analgesia in the coprimary outcomes of the postoperative pain score at 0–2 hours (high-quality evidence) and the need for in-hospital rescue analgesia (moderate-quality evidence consequent to downgrading by publication bias). No subgroup differences in regard to the type of abdominal wall block or the method of block localization were demonstrated for these primary outcomes. Relative to caudal analgesia, II-IH and TAP block reduced the incidence of postoperative motor blockade and the time to micturition.

Conclusions This meta-analysis was limited by unclear risk of selection and performance biases and significant heterogeneity. In summary, II-IH and TAP block are a non-invasive and reasonable alternative to caudal analgesia in pediatric genitourinary surgery.

  • analgesia
  • nerve block
  • pain
  • postoperative
  • regional anesthesia
  • pediatrics
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Footnotes

  • Twitter @edchan2828, @elboghdadly, @DrEAlbrecht

  • Contributors ND: design of meta-analysis, search strategy, screening of results, data collection, statistical analysis, drafting of manuscript and revision of manuscript. EC: screening of results, data collection, statistical analysis and drafting of manuscript. KE-B: design of meta-analysis, screening of results and revision of manuscript. EA: design of meta-analysis and revision of manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests EA has received grants from the Swiss Academy for Anaesthesia Research, Lausanne, Switzerland (50 000 Swiss Francs, no grant number attributed), B. Braun Medical AG (56 100 Swiss Francs, no grant number attributed) and the Swiss National Science Foundation (353 408 Swiss Francs, grant number 32003B_169974/1) in order to support his clinical research, EA has further received honorarium from B. Braun Medical AG. ND, EC and KE declare that they have no conflicts of interest.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data can be shared upon reasonable request.

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