When it comes to paediatric perioperative care, postoperative pain management is essential for improving patient comfort, speeding recovery, and lowering the risk of complications. Children whose pain is not well managed may experience heightened anxiety, disturbed sleep, postponed mobility, lengthened hospital stay, and adverse psychological effects that may last long after surgery has ended. Hence, in paediatric surgery, the use of an effective and safe analgesic method is crucial [1, 2].

 

Because of developmental disparities in pain perception, communication, and physiological reactions, assessing and managing pain in children is a challenging task. Nausea, vomiting, respiratory depression, sedation, and delayed recovery are some of the potential side effects of systemic analgesics such paracetamol, opioids, and nonsteroidal anti-inflammatory medications (NSAIDs) that are commonly used to control postoperative pain. As a result, multimodal analgesic treatments that use regional anaesthesia techniques have been gaining popularity for the purpose of enhancing postoperative outcomes with less systemic medication exposure [3-5].

 

When it comes to regional anaesthesia, the caudal epidural block is a popular choice for paediatric patients having procedures on their lower limbs, urogenital areas, perineal areas, or lower abdominals. By inserting a local anaesthetic into the sacral hiatus and into the caudal epidural region, this method blocks the roots of the sacral and lower lumbar nerves, thus relieving pain. It has been standard practice to use anatomical landmarks to perform caudal blocks; nevertheless, individual differences in anatomy can raise the likelihood of complications, failed or incomplete blocks, and other problems [6, 7].

 

For children experiencing pain after surgery, intravenous (IV) analgesia is still the go-to choice due to its quick start of effect and convenience of administration. Injections of paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs), and opioid pain relievers are common. Although effective, intravenous analgesia typically only alleviates pain for a shorter period of time and may necessitate additional doses or rescue drugs. In addition, respiratory depression, vomiting, nausea, pruritus, and urine retention are some of the side effects that may occur with opioid-based analgesics, especially in younger children [8, 9].

 

Elective lower limb and abdominal procedures in children necessitate pain management strategies, and this study aimed to assess the relative merits of intravenous analgesia, ultrasound-guided caudal epidural blocks, and other options. Finding the best method for controlling postoperative pain in children required measuring postoperative pain scores, duration of analgesia, rescue analgesic requirements, and side events linked to both approaches [10, 11].

 

This prospective randomized comparative study was conducted at the Department of Anesthesia, PSP Medical College Hospital and Research Institute, Kanchipuram Main Road, Oragadam, Panruti, Kancheepuram, Tamil Nadu between March 2024 to January 2025. A total of 30 pediatric patients scheduled for elective surgery under general anesthesia were enrolled in the study. The purpose of this study was to evaluate the relative merits of intravenous (IV) analgesia and ultrasound-guided caudal epidural blocks in alleviating postoperative pain in children having elective procedures on their lower limbs or abdomens. Before the study began, the researchers got approval from the Institutional Ethics Committee. All participants' parents or legal guardians gave their signed informed consent. Anesthetic Technique: Standardised general anaesthesia was administered to all patients in accordance with institutional protocols. After the anaesthesia was induced, participants in Group C were led to the sacral hiatus with a high-frequency linear transducer to guide the placement of the needle during the ultrasound-guided caudal epidural block. A dose of 1 mL/kg of 0.25% bupivacaine was given. As per the usual hospital practice, patients in Group I were given intravenous paracetamol (15 mg/kg) as a postoperative analgesic and at the conclusion of surgery. When necessary, intravenous tramadol (1 mg/kg) was given as a rescue analgesic. Outcome Measures: Postoperative pain intensity, as measured by FLACC scores, was the main outcome measure. The duration of analgesia, the incidence of adverse events, and the demand for rescue analgesic were included as secondary outcome measures. Inclusion Criteria: 1. Children aged 2–12 years. 2. American Society of Anesthesiologists (ASA) physical status I or II. 3. Scheduled for elective lower abdominal, inguinal, urological, perineal. 4. Patients undergoing surgery under general anesthesia. 5. Written informed consent obtained from parents or guardians. Exclusion Criteria: 1. Refusal of parental or guardian consent. 2. Known allergy or hypersensitivity to local anesthetics. 3. Coagulation disorders or ongoing anticoagulant therapy. 4. Infection at the site of caudal block injection. 5. Congenital spinal abnormalities or neurological disorders. 6. Severe systemic disease. 7. Developmental delay interfering with pain assessment. 8. Incomplete data collection or protocol violation. Statistical Analysis: Data were entered into Microsoft Excel and analyzed using SPSS version 26.0. Continuous variables were expressed as mean ± standard deviation (SD), while categorical variables were presented as frequencies and percentages.A p-value < 0.05 was considered statistically significant. The effectiveness of analgesic techniques was evaluated by comparing pain scores, duration of analgesia, rescue analgesic requirements, and incidence of adverse events between the two groups.