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

Table 2

Summary of findings using GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach.

Caudal compared to noncaudal regional analgesia for inguinal surgeries in children
Patient or population: patients with inguinal surgeries in children; Settings: randomised control studies reported in English language; Intervention: caudal; Comparison: voncaudal regional analgesia
Outcomes	Illustrative comparative risks *   (95% CI)		Relative effect; (95% CI)	No. of Participants; (studies)	Quality of the evidence; (GRADE)	Comments
	Assumed risk	Corresponding risk
	Noncaudal eegional analgesia	Caudal
Early rescue analgesia (<4 hrs); Number of children Needing rescue analgesic Medication	Study population		RR 0.81; (0.66 to 0.99)	789; (13 studies)	⊕ ⊕ ⊕ ⊝; 𝑚𝑜𝑑𝑒𝑟𝑎𝑡𝑒^1,2,3
	254 per 1000	206 per 1000; (168 to 251)
	Moderate
	233 per 1000	189 per 1000; (154 to 231)
Late rescue analgesia (4 hrs–24 hrs); Number of children Needing rescue analgesic Medication	Study population		RR 0.81; (0.69 to 0.96)	532; (8 studies)	⊕ ⊕ ⊕ ⊝; 𝑚𝑜𝑑𝑒𝑟𝑎𝑡𝑒^1,2,3
	489 per 1000	396 per 1000; (338 to 470)
	Moderate
	339 per 1000	275 per 1000; (234 to 325)
Adverse effect-motor blockade	Study population		RR 2.68; (1.36 to 5.28)	539; (6 studies)	⊕ ⊝ ⊝ ⊝; 𝑣𝑒𝑟𝑦𝑙𝑜𝑤^1,2,3,4,5,6
	23 per 1000	61 per 1000; (31 to 120)
	Moderate
	0 per 1000	0 per 1000; (0 to 0)
Adverse effect-nausea-vomiting	Study population		RR 1.05; (0.81 to 1.35)	502; (7 studies)	⊕ ⊕ ⊕ ⊝; 𝑚𝑜𝑑𝑒𝑟𝑎𝑡𝑒^1,2,3
	261 per 1000	274 per 1000; (211 to 352)
	Moderate
	222 per 1000	233 per 1000; (180 to 300)
Adverse effects-urinary retention	Study population		RR 2.23; (1.27 to 3.91)	429; (5 studies)	⊕ ⊝ ⊝ ⊝; 𝑣𝑒𝑟𝑦𝑙𝑜𝑤^1,2,3,6,7,8
	62 per 1000	138 per 1000; (79 to 242)
	Moderate
	77 per 1000	172 per 1000; (98 to 301)
Adverse effects-delayed discharge	Study population		RR 3.68; (0.41 to 32.97)	49; (1 study)	⊕ ⊝ ⊝ ⊝; 𝑣𝑒𝑟𝑦𝑙𝑜𝑤^5,6,9,10
	37 per 1000	136 per 1000; (15 to 1000)
	Moderate
	37 per 1000	136 per 1000; (15 to 1000)
Adverse effects-infection-caudal versus infiltration	Study population		RR 0.38; (0.02 to 8.86)	43; (1 study)	⊕ ⊝ ⊝ ⊝; 𝑣𝑒𝑟𝑦𝑙𝑜𝑤^3,5,6,9,10
	43 per 1000	17 per 1000; (1 to 385)
	Moderate
	44 per 1000	17 per 1000; (1 to 390)

∗The basis for the assumed risk (e.g., the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; RR: risk ratio.
GRADE Working Group grades of evidence:
high quality: further research is very unlikely to change our confidence in the estimate of effect;
moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate;
low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate;
very low quality: we are very uncertain about the estimate.
¹There was no appropriate concealment in the majority of the studies.
²Based on available studies, funnel plot looks symmetrical.
³None of the studies were industry funded.
⁴No uniform criteria were considered for assessment of motor blockade.
⁵Wide confidence interval.
⁶Sample size too low to detect a true difference.
⁷No uniform criteria used for assessment of urinary retention.
⁸Several confounders were not controlled appropriately.
⁹No appropriate concealment or random sequence generation.
¹⁰Only a single study.