|
Author,
year, and methods | Participants | Interventions | Outcomes | Notes |
|
| Caudal versus inguinal nerve block |
|
Abdellatif
2012 [8]
RCT, 2 groups, parallel design | Children with unilateral groin surgery
Age: 1–6 yrs | US guided INB against blind CB; both done preoperatively under GA.
No use of adrenaline. | CHEOPS scale and also the number of children needing rescue analgesic provided. | 1 patient in CB and 2 in INB were excluded due to failure. |
|
Fisher et al.,
1993 [9]
RCT, 3 groups, parallel design | Children having herniorrhaphy or orchidopexy
Age: 0.5–10 yrs | 2 groups of CB (with or without the use of epinephrine) against INB;
both done after the procedure. | Primary outcome: postoperative voiding with analgesia outcomes as secondary.Single time point reporting of rescue analgesia. | For the purpose of the review the caudal groups were combined as 1 group.
4 patients in each group were excluded because of failure of interventions. |
|
Markham et al.,
1986 [10]
RCT, 2-arm
parallel trial | Children having herniorrhaphy or orchiopexy
Age: 1–12 years | CB against INB; both done preoperatively, without image guidance under GA.
No use of adrenaline. | The outcome was intraoperative and postoperative analgesia. | |
|
Scott et al.,
1989 [11]
RCT, 2-arm
parallel trial | Children having herniorrhaphy or orchiopexy
Age: 3–8 years | CB against INB; both done preoperatively, without image guidance under GA.
No use of adrenaline. | Primary outcome: effectiveness of postoperative analgesia. | |
|
Hanallah et al.,
1987 [12]
RCT, 3-arm
parallel trial | Orchidopexy
Age: 18 months–12 years | CB against INB, with the 3rd group acting as a control.
All interventions done after surgery, without image guidance
No use of adrenaline. | Primary outcome: postoperative analgesia as median and range without specifying the time point. | Not included in the quantitative analysis.
The authors also combined both treatment groups compared to the control group to report the use of rescue analgesia. |
|
| Caudal versus infiltration |
|
Machotta et al.,
2003 [13]
RCT, 2-arm
parallel trial | Children having unilateral Hernia
Age: 0–5 yrs | CB against wound infiltration; both done after the surgery.
No Image guidance or use of epinephrine. | Postoperative analgesia. Hannalah scale as well as children needing rescue analgesic. | Adverse events are not specifically (individually) reported. |
|
Lafferty et al.,
1990 [14]
RCT, 2-arm
parallel design | Children having orchiopexy
Age: 2–15 years | CB done preoperatively versus wound infiltration done before full surgical closure. No image guidance or use of epinephrine. | Postoperative analgesia by a 10 cm linear analogue scale and use of rescue analgesia. | Poor reporting of methods and outcome assessment |
|
Fell et al.,
1988 [15]
RCT, 2-arm
parallel design | Children having inguinal herniotomy
Mean age
CB: 4.5 ± 2.9 yrs
INF: 3.7 ± 2.5 yrs | Caudal done preoperatively versus wound infiltration after surgery.
No image guidance or use of epinephrine | Analgesia rated on a 3-point scale. Proportions of patients who were pain free provided. | Calculation of the number of children needing rescue analgesic was done indirectly.
1 patient was excluded as the data was incomplete. |
|
Conroy et al.,
1993 [16]
RCT, 3-arm
parallel trial,
with a
control group. | Children having a bilateral inguinal hernia
Age: 2 months–10 years | CB done preoperatively versus INF after surgery.
No image guidance.
Epinephrine used in both groups. | Postoperative analgesia. Specific time point used to calculate the number of rescues analgesic not clearly mentioned. | Children in the control group were not included in this review.
Confusion in the randomization code, in the first 30 pts, led to more children having caudal blocks. |
|
Jahromi et al.,
2012 [17]
RCT, 3-arm
parallel design | Unilateral inguinal hernia
Age: 0.3–7 years | Caudal versus INF, both done after the surgery.
No image guidance or epinephrine was used.
3rd group of acetaminophen was not included | Analgesia in FLACC scale and also reported as the number needing rescue analgesic. | 3 children in the caudal group were excluded because of failed caudal. |
|
Schindler et al.,
1991 [18]
RCT, 2-arm
parallel design | Unilateral inguinal hernia
Age: 2 months–12 years | CB done preoperatively versus INF done before full surgical closure. No image guidance or epinephrine used. | Analgesia in CHEOPS scale and also reported as the number needing rescue analgesia. | |
|
| Caudal versus combined wound infiltration and inguinal N block |
|
Tobias et al.,
1995 [19]
RCT, 2-arm
parallel design | Children having inguinal hernia with additional laparoscopic inspection of contralateral peritoneum
Mean age
CB: 1.2 ± 0.2 yrs
Comparator: 1.3 ± 0.4 yrs | CB placed presurgically versus INB and INF.
No image guidance. Epinephrine used in both arms. | Analgesia using Hannalah scale and also reported as the number needing rescue analgesia. | Laparoscopic inspection involved. |
|
Splinter et al.,
1995 [20]
RCT, 2-arm
parallel design | Children having inguinal hernia repair
Age: 1–13 years | CB placed presurgically versus INB and INF placed after surgery.
No image guidance. Epinephrine used in both arms. | Analgesia using mCHEOPS scale and also reported as the number needing rescue analgesic. | |
|
Cross and battett
1987 [21]
RCT, 2-arm
parallel design | Children having herniotomy or/and orchidopexy; unilateral or bilateral included.
Age: 1–13 years | CB versus INB and INF, all placed before surgery.
No image guidance. Epinephrine used only in the comparator group. | Analgesia using linear analogue scale and also reported as the number needing rescue analgesic. | The dose of local anesthetic was different depending on unilateral and bilateral surgeries. |
|
Somri et al.,
2002 [22]
RCT, 2-arm
parallel design | Children having orchidopexy
Age: 1–8 years | CB versus combined INB and INF.
No image guidance or use of epinephrine. | Primary outcome-effect of catecholamine level. Analgesia as a secondary outcome, reported as the number needing rescue analgesic. | The report is titled as a comparison of CB versus INB; however the methods mention that they supplemented the INB with INF. |
|
Bhattarai et al.,
2005 [23]
RCT, 2-arm
parallel design | Children having herniotomy
Age: 1–14 years | CB versus combined INB and INF; all interventions done after surgery.
No image guidance used. | Analgesia reported as mean duration and also as the number needing rescue analgesic. | |
|
| Caudal versus others |
|
Tug et al.,
2011 [24]
RCT, 2-arm
parallel design | Inguinal hernia
Age: 3–7 years | CB versus PVB; both placed presurgically. | Rescue analgesia at 2 and 4 hrs and also in mean (±SD scores). | 2 (PVB) and 4 (CB) were excluded due to technical failures. |
|
