Comparison of Erector Spinae Plane Block and Caudal Block in Pediatric Patients Aged 1 to 8 Years Undergoing Lower Abdominal Surgery

In routine pediatric surgical practice, lower abdominal surgeries are commonly performed. Inadequate control of postoperative pain can hinder functional recovery and may lead to negative behavioral changes as well as parental dissatisfaction. Regional anesthesia techniques are widely recommended for pain management in pediatric surgery, as they reduce the need for parenteral opioids and improve the effectiveness of postoperative pain control, patient comfort, and parental satisfaction.

Various nerve block techniques have been developed to enhance postoperative analgesia and facilitate recovery in pediatric patients. However, there is still no consensus regarding the most effective regional anesthesia strategy for pediatric surgical procedures.

Among regional anesthesia techniques used for pain management in children undergoing lower abdominal surgery, caudal block remains the most commonly applied method. The introduction of real-time ultrasound guidance has improved the reliability and safety of caudal blocks. Nevertheless, a major limitation of this technique is its relatively short duration of action following a single injection, even when long-acting local anesthetics or adjuvant agents are used. Consequently, several fascial plane blocks, such as the quadratus lumborum block, transversus abdominis plane block, and rectus sheath block, have been proposed as alternative approaches for postoperative analgesia in children.

The erector spinae plane block is a regional anesthesia technique that has been applied at thoracic, lumbar, cervical, and sacral levels for both acute and chronic pain management. By providing blockade of both somatic and visceral pain pathways, it has demonstrated effective postoperative analgesic properties in a variety of thoracic and abdominal surgical procedures. The technique involves the injection of a local anesthetic into the interfascial plane between the erector spinae muscle and the transverse process, allowing longitudinal spread of the anesthetic across multiple spinal levels.

With a growing body of evidence supporting its feasibility and effectiveness, the erector spinae plane block has gained increasing attention in pediatric anesthesia practice.

The aim of this study is to evaluate and compare the analgesic efficacy and safety of ultrasound-guided erector spinae plane block and caudal block in pediatric patients undergoing unilateral lower abdominal surgery under general anesthesia. The primary objective is to compare postoperative pain levels between the two techniques using the FLACC score, which assesses facial expression, leg position, activity, crying, and consolability. Secondary objectives include the evaluation of intraoperative heart rate, blood pressure, and oxygen saturation, block application times, parental satisfaction, and the incidence of postoperative side effects.

Study Overview

• Status: Not yet recruiting
• Conditions: Erector Spinae Plane Block; Pediatric; Caudal Epidural Anesthesia
• Intervention / Treatment: Procedure: caudal block; Procedure: Erector Spinae Plane Block

• Study Type: Interventional
• Enrollment (Estimated): 78
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Vildan Ergen, Associate Professor; Phone Number: 905321511040; Email: vildanergen06@gmail.com
• Study Contact Backup: Name: Zeki D Kuvet, MD; Phone Number: 905397959579; Email: zekidemirhankuvet@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

Children aged 1 to 8 years

Scheduled for elective lower abdominal surgery

American Society of Anesthesiologists (ASA) physical status I-II

Written informed consent obtained from parent(s) or legal guardian(s)

Exclusion Criteria:

Presence of anatomical abnormalities

Coagulation disorders

Infection at the site of block application

Severe cardiovascular, neurological, respiratory, or metabolic disease

Known allergy to study medications

Failed regional block

Bilateral surgery or additional surgical procedures involving different surgical sites

Refusal of parent(s) or legal guardian(s) to provide consent

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Caudal Block Group; Participants will receive an ultrasound-guided caudal epidural block with bupivacaine.	Procedure: caudal block; A single-shot ultrasound-guided caudal epidural block will be performed via the sacral hiatus using a standard technique.
Active Comparator: Erector spinae plane block group; Participants will receive an ultrasound-guided erector spinae plane block with bupivacaine.	Procedure: Erector Spinae Plane Block; A single-shot ultrasound-guided erector spinae plane block will be performed at the L1 transverse process level using an in-plane technique.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
FLACC pain score	Postoperative pain will be assessed using the FLACC scale. Unit of Measure: Score (0-10)	0, 30 minutes; 1, 2, 4, 8, 12, and 24 hours after surgery

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Time to first rescue analgesia	Time from the end of surgery to the first administration of rescue analgesic	Up to 24 hours postoperatively
Duration of Effective Analgesia	Time from block application to the first FLACC pain score ≥4	Up to 24 hours postoperatively
Duration of Anesthesia	Time from anesthesia induction to awake extubation	Intraoperative period
Duration of Surgery	Time from skin incision to skin closure	Intraoperative period
Block Performance Time	Time from needle insertion to completion of block procedure	Intraoperative period
Intraoperative Heart Rate	Heart rate measured intraoperatively	0, 15, 30, 45 minutes and 1 hour after inductio
Intraoperative Mean Arterial Pressure	Mean arterial pressure measured intraoperatively	0, 15, 30, 45 minutes and 1 hour after induction
Intraoperative Oxygen Saturation	Peripheral oxygen saturation measured intraoperatively	0, 15, 30, 45 minutes and 1 hour after induction
Postoperative Adverse Events	Incidence of postoperative adverse events including nausea, vomiting, nerve injury, or infection	First 24 hours postoperatively

Collaborators and Investigators

• Sponsor: Ankara City Hospital Bilkent
• Investigators: Principal Investigator: Zeki D Kuvet, Ankara City Hospital Bilkent

Study record dates

Study Major Dates

• Study Start (Estimated): April 15, 2026
• Primary Completion (Estimated): September 1, 2026
• Study Completion (Estimated): September 1, 2026

Study Registration Dates

• First Submitted: November 17, 2025
• First Submitted That Met QC Criteria: February 16, 2026
• First Posted (Actual): February 23, 2026

Study Record Updates

• Last Update Posted (Actual): May 11, 2026
• Last Update Submitted That Met QC Criteria: May 6, 2026
• Last Verified: October 1, 2025

More Information

Terms related to this study

• Keywords: pediatric; erector spinae plane block; caudal block; espb
• Additional Relevant MeSH Terms: Organic Chemicals; Anilides; Amides; Aniline Compounds; Amines; Behavioral Disciplines and Activities; Digestive System and Oral Physiological Phenomena; Behavioral Sciences; Dentistry; Dental Physiological Phenomena; Bupivacaine; Dental Occlusion; Parapsychology
• Other Study ID Numbers: TABED 1-25-1436

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No