Comparison of Sacral Erector Spinae Plane Block vs. Ring Block for Postoperative Analgesia Management Following Circumcision Surgery: A Prospective, Randomized, Controlled Multicenter Trial

<b>Background and Objectives:</b> Circumcision is the most frequently performed surgery in male pediatric patients. The postoperative period is characterized by significant pain due to the sensitivity of the foreskin and low pain threshold in children. This study aimed to evaluate the effects of sacral erector spinae plane block (S-ESPB) and ring block on postoperative face, legs, activity, cry, and consolability (FLACC) pain scores after circumcision in children. We also assessed the amount of rescue analgesia used, the time to the first administration of rescue analgesia, potential problems, and parental satisfaction. <b>Materials and Methods:</b> This study was a prospective, randomized, multicenter trial conducted at two tertiary healthcare centers in Turkey. The patients were divided into two groups: Group S (patients who received the S-ESPB) and Group R (patients who received the ring block). The primary outcome measure was the FLACC score at 1 h postoperatively. Secondary outcome measures included FLACC scores at 0, 2, 4, and 6 h after surgery, the total dose of rescue analgesia, time to first rescue analgesia, complications, and parental satisfaction. <b>Results:</b> Group S exhibited significantly lower FLACC scores than Group R at all time (0, 1, 2, 4, and 6 h) points (respectively, <i>p</i> = 0.013, <i>p</i> < 0.001, <i>p</i> = 0.004, <i>p</i> = 0.006, and <i>p</i> = 0.002). Group S required significantly less rescue analgesia and exhibited a significantly longer duration of analgesic efficacy compared to Group R (<i>p</i> = 0.001 and <i>p</i> = 0.002, respectively). <b>Conclusions:</b> The S-ESPB is a safe and effective form of analgesia for managing pain following pediatric circumcision surgery.