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) |
⊕⊕
⊕⊝
mo de ra te 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) |
⊕⊕
⊕⊝
mo de ra te 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) |
⊕⊝
⊝⊝
ve ry low 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) |
⊕⊕
⊕⊝
mo de ra te 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) |
⊕⊝
⊝⊝
ve ry low 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) |
⊕⊝
⊝⊝
ve ry low 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) |
⊕⊝
⊝⊝
ve ry low 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.