Ultrasound-Guided Pudendal Nerve Block versus Caudal Block for Post-Operative Analgesia in Penile Surgeries in Children

Abstract

Abstract Background Penile surgeries as hypospadias, urethroplasty and circumcision are of the most frequently performed surgical procedures in the pediatric male population. Using optimal analgesic regimen provide safe and effective analgesia, reduce postoperative stress response and accelerate recovery from surgery. This study was to compare the effectiveness and safety of ultrasound (US) guided pudendal nerve block (PNB) versus caudal block (CB) for postoperative analgesia in pediatric male patients undergoing penile surgeries. Methods The study was conducted on 40 randomly chosen patients in Ain Shams University Hospitals after approval of the medical ethical committee. Patients were divided randomly into two groups (20 each group) either receiving ultrasound-guided pudendal nerve block (PNB group) or caudal epidural block (CB group). In the PNB group, patients were injected with 0.3 mL/kg 0.25% bupivacaine and 1 ug/kg fentanyl. In the CB group, patients were injected with 1 mL/kg 0.25% bupivacaine and 1 ug/kg fentanyl. The two groups were adequately monitored and assessed pre, intra and post-operatively and they were compared regarding demographic data, pre, intra and postoperative hemodynamics, postoperative pain control using objective pain scale (OPS) score, consumption of paracetamol in the 1st 24 hours postoperatively and complications of both anesthetic techniques. Results This prospective randomized controlled single-blind clinical study was performed on total 40 patients of age 3 to 10 years scheduled for penile surgeries. For the primary outcome, there was a statistically significant increase in time to first analgesia in PNB group than CB group with p value < 0.001 while there was a statistically significant increase in total dose of paracetamol in CB group than PNB group with p value < 0.001. For OPS score, there was a statistically significant increase in pain score in CB group than PNB group at 6 h, 12 h and 24 h with p value = 0.02, 0.005 and 0.01, respectively. Conclusion From our study we can conclude that US guided PNB provided significantly prolonged postoperative analgesia and reduced the postoperative analgesic requirements as compared with caudal block in pediatric patients undergoing penile surgeries and also demonstrated that both analgesic techniques are safe.