Analgesic efficacy of sacral erector spinae plane block in pediatric infraumbilical surgeries: a systematic review and meta-analysis of randomized controlled trials
Minerva Anestesiologica, cilt.92, sa.3, ss.209-220, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 92 Sayı: 3
- Basım Tarihi: 2026
- Doi Numarası: 10.23736/s0375-9393.25.19327-9
- Dergi Adı: Minerva Anestesiologica
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, EMBASE, MEDLINE
- Sayfa Sayıları: ss.209-220
- Anahtar Kelimeler: Pediatrics, Surgery, Postoperative care, Analgesia, Anesthesia, conduction
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
INTRODUCTION: Pediatric infraumbilical surgeries often lead to significant postoperative pain. Sacral erector spinae plane block (S-ESPB) is a novel ultrasound-guided technique that targets the sacral fascial plane and may provide extended analgesia with minimal motor block. This systematic review and meta-analysis evaluate the efficacy and safety of S-ESPB in pediatric patients compared to conventional regional techniques or no block at all. EVIDENCE ACQUISITION: This review adhered to PRISMA 2020 guidelines and was registered with PROSPERO (CRD420251054390). A systematic search of PubMed, Scopus, Web of Science, and CENTRAL was conducted. Eligible studies included randomized controlled trials comparing S-ESPB to caudal blocks, penile blocks, ring blocks, or no block in pediatric patients. The primary outcome was time to first request for rescue analgesia. Secondary outcomes encompassed early postoperative (Face, Legs, Activity, Cry, Consolability) FLACC scores, 24-hour paracetamol consumption, the need for rescue analgesia, and adverse events. The risk of bias was evaluated using RoB 2, and the evidence’s certainty was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). EVIDENCE SYNTHESIS: Six trials involving 437 participants were included in the review. S-ESPB significantly prolonged the time to first request for rescue analgesia compared to caudal, ring, penile, or no block (SMD: 4.02; 95% CI: 0.92-7.11; P=0.011). Subgroup analyses revealed significantly longer durations with S-ESPB compared to caudal block (SMD: 4.64; 95% CI: 0.84-8.44), ring block (SMD: 1.61; 95% CI: 0.97-2.25), and no block (SMD: 3.97; 95% CI: 2.90-5.04). Cumulative paracetamol consumption at 24 hours was significantly reduced with S-ESPB (SMD: -2.24; 95% CI: -3.13 to -1.35; P<0.001). No significant differences were found in early pain scores or rates of rescue analgesia. Adverse events were rare and comparable to those in the control groups. CONCLUSIONS: S-ESPB provides prolonged postoperative analgesia and reduces systemic analgesic consumption in pediatric infraumbilical surgery, with a favorable safety profile.