Comparative Study between Ultrasound Guided Sacral Erector Spinae and Caudal Block for Pain Control after Hypospadias Surgery

Background: Hypospadias reconstruction is frequently accompanied by significant postoperative discomfort. Traditionally, the CB has been the standard technique for providing analgesia in pediatric patients; however, the ultrasound-guided sacral ESPB has recently gained attention as a potential and effective alternative. Aim: This study compared analgesic effectivenesss and safety of sacral ESPB versus CB among children having hypospadias repair. Methods: This prospective, randomized, double-blind trial included eighty male children aged 1–5 years (ASA I–II) scheduled for coronal or subcoronal hypospadias repair. Patients were randomly assigned to two equal groups: Group CB received a caudal epidural block, and Group ES received a bilateral sacral erector spinae plane block (ESPB). Both groups were administered bupivacaine 0.25% (2 mg/kg) combined with lidocaine 3 mg/kg. Postoperative pain was evaluated at predetermined intervals using FLACC scale. Intravenous paracetamol (15 mg/kg) was given as rescue analgesia when the FLACC score was ≥3. Primary outcomes were time to first rescue analgesia and total paracetamol intake, while secondary outcomes included serial FLACC scores, incidence of complications, and parental satisfaction. Results: Demographic and intraoperative variables were comparable. ESPB group had significantly longer time to first rescue analgesia (13.23 ± 1.12 h vs. 8.05 ± 1.38 h, p < 0.001) and lower paracetamol consumption (492.75 ± 137.21 mg vs. 609 ± 151.03 mg, p < 0.001). • FLACC scores were significantly lower in Group ES at 6 and 8 hours postoperatively compared with Group CB. (p < 0.05). Hemodynamics and complications were similar, while parental satisfaction was higher with ESPB (p = 0.02). Conclusion: Ultrasound-guided sacral ESPB provides superior, longer-lasting analgesia with comparable safety to caudal block in children undergoing hypospadias surgery.