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Informed consent was obtained from all participants or their legal guardians prior to participation in the study. The purpose, procedures, potential risks, and benefits of the study were explained to each participant, and written informed consent was obtained. For participants under the age of 18, informed consent was obtained from their parents or legal guardians. All personal data were handled confidentially, and all efforts were made to ensure the privacy and anonymity of the participants throughout the study. It was registered with the Chinese Clinical Trial Registry (\n                      \n                      ) with registration number: ChiCTR2300072599, registration date: 2023-06-19.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"This study does not contain any individual person\u2019s data in any form (including any individual details, images or videos) that compromise anonymity. Therefore, it is not applicable to include a consent for publication statement in this section.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"a. What is already known about the topic: Caudal block anesthesia, particularly when combined with general anesthesia, has been shown to effectively reduce postoperative pain and limit immunosuppression in pediatric surgeries by lowering the release of stress hormones and inflammatory mediators.b. What new information this study adds: This study demonstrates that the combination of hydromorphone with ropivacaine for caudal block anesthesia results in superior postoperative pain relief and a faster recovery of immune function, as indicated by higher levels of T lymphocyte subsets (CD3\n                      +\n                      , CD4\n                      +\n                      , and CD4\n                      +\n                      \/CD8\n                      +\n                      ratios) compared to ropivacaine alone.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Clinical implications"}},{"value":"In accordance with BMC Series editorial policies, this study adheres to the CONSORT guidelines for reporting clinical trials. A completed CONSORT checklist is available as a supplementary file.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Clinical implications"}}],"article-number":"172"}}