A Comparative Study between Caudal and Penile Blockade in Pediatric Patients Undergoing Hypospadias Repair

Abstract

Abstract Background Regional anesthesia, in combination with general anesthesia, is frequently used for children undergoing surgical procedures. Aim of the Work to compare postoperative analgesia between caudal block and penile block with bupivacaine in elective hypospadias repair cases in pediatric patients. Patients and Methods This study is a randomized clinical study conducted in the operating theaters of pediatric surgery unit in Ain shams university hospitals. The study was performed after ethical committee approval and informed consent from the parents after full explanation of the procedure, possible side effects and complications. This study was done in the period between March 2019 and August 2019.it included sixty male children undergoing hypospadias repair. Results Postoperative pain was evaluated by FLACC pain score at PACU, 2, 4 and 8, 12, 16 and 24 hrs. There was a significant increase in the pain score in group C starting from the fourth hour postoperativly and thereafter every hour, while the lowest pain scores were recorded in group P (P < 0.05). Also, the time to first need for rescue analgesia was significantly shorter in group C (240 +/-105 min) compared with group P (720 +/-301) (P>0.01).The total rescue analgesic requirement was significantly lower in group P (168.26 +/22.69) than group C (573.8+/- 124.1) (P < 0.01).Postoperative time of ambulation was significantly lower in group C (6.95+/- 3.22) compared with group P (5.28+/-1.99) (P < 0.01). Conclusion Dorsal penile nerve block in children undergoing penile surgery provides effective and a longer duration of postoperative analgesia and decreased postoperative analgesic requirements with more hemodynamic stability both intraoperatively and postoperatively, as it is safer and easier to perform, with higher success rates than caudal epidural block, which is invasive and shows some difficulty in practice.