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BioMed Research International
Volume 2014, Article ID 890626, 17 pages
http://dx.doi.org/10.1155/2014/890626
Review Article

A Systematic Review and Meta-Analysis of Caudal Block as Compared to Noncaudal Regional Techniques for Inguinal Surgeries in Children

1Department of Anesthesiology, McMaster University, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON, Canada L8N 4A6
2IWK Health Centre and Dalhousie University, Halifax, NS, Canada B3K 6R8
3Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada L8N 4A6

Received 16 May 2014; Accepted 10 June 2014; Published 5 August 2014

Academic Editor: Patricia Khashayar

Copyright © 2014 Harsha Shanthanna et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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], ) and late (RR = 0.81 [0.69, 0.96], ) 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.