الفهرس 
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Abstract
Regional anesthesia in children became increasingly popular over last few decades, a variety of peripheral and central nerve blocks have been developed to ensure effective control of perioperative pain. ESPB is a relatively new interfacial plane block that is used for postoperative analgesia in penile surgeries in pediatrics. Examination of the anatomy of the erector spinae muscle groups reveal that it extends from the cervical to the sacral region therefore ESPB can be performed at different levels along the vertebral column. The sacral ESPB is a technique known to block the posterior branches of the sacral nerves. Also, it blocks the lumbosacral plexus especially the sacral spinal nerves (S2_S4) when applied to high levels. Caudal epidural block in children is one of the most widely administrated techniques of regional anesthesia; it is an efficient way to offer perioperative analgesia for painful sub umbilical interventions. It enables early ambulation, hemodynamic stability and spontaneous breathing in patient groups at maximum risk of difficult airway. CB is a known worldwide technique but with some risks such as subdural, intra vascular injection, infection or injury to the nerve root. Therefore, we try a new technique as sacral ESPB. The study aimed to compare the efficacy of ultrasound guided Sacral ESPB to CB on pain management in penile surgeries in pediatrics. This prospective randomized double blinded study was carried out in pediatric surgery and urology department in Tanta University Hospitals over period of 15 months. Patients were randomly divided equally into two groups. group I (CB): 35 patients, who were received (plain bupivacaine 0.25% 1 mg/kg + 2 % lidocaine 3 mg /kg) in total volume 1ml/ kg max 20 ml via Ultrasound Guided CB. group II (sacral erector spinae): 35 patients, who were received (plain bupivacaine 0.25% 1 mg/kg + 2 % lidocaine 3 mg /kg) in total volume of 1 ml/ kg maximum 20ml divided in both sides via Ultrasound Guided sacral ESPB. Summary of our results: • Comparison between the two studied groups as regard to age, weight, ASA, surgery type and duration of the surgery showed insignificantly different as P value was 0.591, 0.183, 0.445, 0.708 and 0.376 respectively. • Comparison between the two studied groups as regards intraoperative heart rate showed insignificant differences as P value was 0.076, 0.798, 0.122, 0.401, 0.334, 0.341, 0.281, 0.629 and 0.591 respectively. • Comparison between the two studied groups as regard to intraoperative mean arterial blood pressure showed insignificantly different as P value was 0.546, 0.957, 0.083, 0.162, 0.083, 0.961, 0.851, 0.910 and 0.516 respectively. • Comparison between the two studied groups as regard to postoperative heart rate showed insignificantly different at 30min, 2h, 12h and 24h as P value was 0.055, 0.085, 0.059 and 0.139 respectively. Postoperative heart rate measurements were significantly lower at 4h, 6h and 18h in group II than group I (P value <0.05) Comparison between the two studied groups as regard to postoperative mean arterial blood pressure showed insignificantly different at 30min, 2h, 12h and 24h as P value was 0.100, 0.292, 0.758 and 0.976 respectively. Postoperative mean arterial blood pressure measurements were significantly lower at 4h, 6h and 18h in group II than group I (P value <0.05). • Comparison between the two studied groups as regard to FLACC showed insignificantly different at 2h, 12h and 24h as P value was 0.635, 0.138 and 0.367 respectively and were significantly lower at 4h, 6h and 18h in group II than group I (P value <0.05). • The mean ±SD of time to first analgesic request was 6.7 ± 1.34 h in group I and 10.4 ± 2.44 h in group II. The mean ±SD of total paracetamol dose in 1st 24 hours postoperative was 641.7 ± 175.34 mg in group I and 515.7 ± 164.8 mg in group II. • Time to first analgesic request was significantly prolonged in group II than group I (P value <0.001). Total paracetamol dose in 1st 24 hours postoperative was significantly lower in group II than group I (P value <0.001). • Comparison between the two studied groups as regards postoperative nausea and vomiting, bradycardia and hypotension showed insignificantly different as P value was 0.420, 0.393 and 0.495 respectively.