title: A systematic review and meta-analysis of caudal block as compared to noncaudal regional techniques for inguinal surgeries in children.
abstract: This systematic review and meta-analysis were designed to compare the analgesic effectiveness and adverse effects with the use of caudal analgesia as compared to noncaudal regional analgesia techniques in children undergoing inguinal surgeries. MEDLINE, EMBASE, and CENTRAL (Cochrane) databases were searched for randomized control trials published in English language from 1946 up to 2013. Use of rescue analgesia and adverse effects were considered as primary and secondary outcomes, respectively. Outcomes were pooled using random effects model and reported as risk ratio (RR) with 95% CI. Out of 3240 hits and 24 reports for final selection, 17 were included in this review. Caudal analgesia was found to be better in both early (RR = 0.81 [0.66, 0.99], P = 0.04) and late (RR = 0.81 [0.69, 0.96], P = 0.01) periods, but with a significant risk of motor block and urinary retention. According to GRADE, the quality of evidence was moderate. Although potentially superior, caudal analgesia increases the chance of motor block and urinary retention. There are limited studies to demonstrate that the technical superiority using ultrasound translates into better clinical success with the inguinal nerve blocks.
authors.affiliation: Department of Anesthesiology, McMaster University, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON, Canada L8N 4A6.
authors.forename: Harsha
authors.initials: H
authors.lastname: Shanthanna
authors.affiliation: IWK Health Centre and Dalhousie University, Halifax, NS, Canada B3K 6R8.
authors.forename: Balpreet
authors.initials: B
authors.lastname: Singh
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada L8N 4A6.
authors.forename: Gordon
authors.initials: G
authors.lastname: Guyatt
mesh_terms: D000763:Anesthesia, Caudal / Q000379:methods*; D002648:Child; D006552:Hernia, Inguinal / Q000473:pathology / Q000601:surgery*; D006801:Humans; D016239:MEDLINE; D009407:Nerve Block / Q000379:methods; D059408:Pain Management