Children Undergoing Hypospadias Repair Research Articles

Effect of Intravenous Paracetamol on Postoperative Recovery in Children Undergoing Hypospadias Repair under General Anaesthesia with Caudal Block: A Randomised Controlled Trial.

To explore the impact of perioperative intravenous (IV) paracetamol, administered with caudal ropivacaine on the quality of postoperative recovery in children undergoing hypospadias repair. Double-blinded randomised controlled trial. Place and Duration of the Study: The operating room, post-anaesthesia care unit (PACU), and paediatric surgical ward at the Aga Khan University Hospital, from 31st January 2019 to 1st May 2022. Children aged 3-10 years undergoing hypospadias repair were randomly divided into two groups. Group P was administered IV paracetamol 15 mg/kg an hour before the completion of the repair procedure. Group C received a placebo instead of paracetamol. Modified Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) was measured at 15 and 30 minutes, and at 1, 2, 4, and 6 hours postoperatively. The sedation score was documented for four hours postoperatively. Out of total 59 children included in the analysis, 55% (n = 16) in the Group P and 45% (n = 13) in the Group C needed additional analgesia within the first six hours post-procedure. No significant variations were observed between the groups' CHEOPS scores and sedation levels. The addition of perioperative intravenous paracetamol 15 mg/kg in combination with 0.25% ropivacaine through the caudal route, along with general anaesthesia, did not significantly affect the quality of postoperative recovery in children measured by pain score and sedation. Intravenous paracetamol, Caudal analgesia, Ropivacaine, Paediatric patients.

Role of adding dexmedetomidine, ketamine, and magnesium sulphate to caudal block as preemptive analgesia in hypospadias repair in pediatrics: A randomized double-blinded prospective trial

ABSTRACT Background The caudal block (CB) is a quick, and safe approach for pediatric analgesia. Numerous adjuvants were added to extend the analgesia duration. Our trial aims to evaluate the significance of CB by adding dexmedetomidine, ketamine, and MgSO₄ to bupivacaine to provide postoperative analgesia in children undergoing hypospadias repair. Methods This randomized double-blinded study was performed on 75 male children undergoing hypospadias repair under CB. Patients were randomized into three equal groups. All received 0.5 ml/kg bupivacaine 0.25% caudally plus 1 ml volume containing either dexmedetomidine 1 μg/kg in Group D, 0.5 mg/kg ketamine in Group K or 50 mg of MgSO₄ in Group M. Results Time of first rescue analgesia was significantly delayed in group D (8.2 ± 3.45 h) than in group K (5.8 ± 2.85 h) and group M (3.7 ± 1.51 h) (P value = 0.007 vs. <0.001) and in group K than in group M (P value = 0.027). Heart rate and mean arterial blood pressure measurements after block and 60 min intraoperative reduced significantly in group D than in K and Group M. At 6 h and 12 h, FLACC scores were considerably lower with Group D compared to Group K, and Group M, and ketamine group compared to Group M at 4 h. The total amount of pethidine consumed 24 hours postoperatively was significantly lower in Group D than in Group K and Group M. Conclusions Dexmedetomidine as an additive to the CB significantly prolonged time to first analgesia required and decreased total rescue opioid consumption compared to ketamine and MgSO₄.

Efficacy of adding nalbuphine to caudal bupivacaine for postoperative analgesia in children undergoing hypospadias repair surgery. Randomized controlled trial

ABSTRACT Background We hypothesized that adding nalbuphine to bupivacaine would prolong the duration of caudal epidural anaesthesia (CEA) in pediatric patients undergoing hypospadias repair surgery. Methods 60 children scheduled for elective hypospadias surgery under general anesthesia combined with CEA were divided into two equal groups: the control group received caudal bupivacaine 0.25% 1 ml/kg plus 2 ml normal saline. The Nalbuphine group received caudal bupivacaine 0.25% 1 ml/kg plus nalbuphine 0.1 mg/kg in 2 ml normal saline. Intraoperative and postoperative rescue analgesia was managed by giving intravenous paracetamol 15 mg/kg and/or 100mcg nalbuphine. The Face, Legs, Activity, Cry, Consolability (FLACC) pain scale, and the Richmond AgitationSedation Scale (RASS) score were measured. Pre-operative and postoperative blood samples were collected for a subgroup of patients for cortisol analysis. Results The duration of postoperative analgesia was significantly longer in the nalbuphine group (p < 0.001). The number of patients who needed postoperative supplemental analgesia was significantly lower in the nalbuphine group (p < 0.001). Total paracetamol consumption was significantly higher in the control group (p < 0.001). The FLACC and RASS were significantly lower in the nalbuphine group. Postoperative cortisol levels were lower in the nalbuphine group compared to the control group. Conclusions Adding caudal nalbuphine 0.1 mg/kg to bupivacaine 0.25% provides better postoperative pain control than bupivacaine alone in children undergoing hypospadias repair.

A Prospective Observational Study Analyzing the Analgesic Efficacy of Caudal Block and Nerve Stimulator-Guided Pudendal Nerve Block in Children Undergoing Hypospadias Repair.

Hypospadias repair is a common pediatric surgery. While caudal block (CB) is the most widely used procedure for analgesia, pudendal nerve block (PNB) can be utilized as an alternative. We evaluated the postoperative analgesic efficacy of CB and PNB in children undergoing hypospadias repair. In this prospective observational study, we evaluated 101 patients who received standard general anesthesia along with CB or PNB. Postoperative pain score (Face, Legs, Activity, Cry, and Consolability {FLACC} score) along with the total number of analgesicdoses and the total amount of analgesic drugs consumed within 24 hours were noted. Time to first rescue analgesia, post-block penile length and midshaft circumference, surgeon satisfaction score, and postoperative complications were also evaluated. Out of 101 patients observed, 50 received CB, and 51 received PNB. At 24-hour interval, the median FLACC score in CB was 6, while in the PNB, it was 4 (p<0.001). None of the patients who were given PNB received more than three doses (p<0.001), and the average consumption of analgesic drugs within 24 hours was significantly higher in CB (38.4±4.28) compared to PNB (21.7±6.33) (p<0.0001). The median time to first rescue analgesia in CB was four hours, while in patients receiving PNB, it was eight hours(p<0.001). The increase in penile volume was significantly higher with CB as compared to PNB (p<0.001). Surgeon satisfaction score was found to be better with PNB (p<0.002). Patients who received PNB had significantly reduced pain scores and analgesic consumption in the first 24 hours post surgery.

COMPARISON OF DEXMEDETOMIDINE AND CLONIDINE AS ADDITIVE WHEN GIVEN SEPARATELY, PREMIXED WITH 0.25% ROPIVACAINE IN PEDIATRIC CAUDAL BLOCK, ON INTRA OPERATIVE ANESTHETIC/ ANALGESIC DRUG REQUIREMENT AND DURATION OF POST OPERATIVE ANALGESIA IN HYPOSPADIAS REPAIR SURGERIES

Aim:Comparison of dexmedetomidine and clonidine as additive when given separately, premixed with 0.25% ropivacaine in pediatric caudal block,on intra operative anesthetic/ analgesic drug requirement and duration of post operative analgesia in hypospadias repair surgeries. Methods and Materials:Children,whose parents or guardians,were willing to give consent and fulfilled inclusion criteria were selected for the study.Thepatients were randomly allocated, by double blinding into two groups. Group RD received 0.25% ropivacaine 1 ml/kg +2µg/kg dexmedetomidine (in 0.5 ml volume).Group RC received 1 ml/kg of 0.25% ropivacaine + 1 µg/kg of clonidine (in 0.5 ml volume). Results:Mean age of patients receiving dexmedetomidine and clonidine was 3.20±1.821 and 4.47±1.727 years respectively. No significant difference was obtained in terms of mean age.Blood pressure,Heart rate and Saturation was maintained by both dexmedetomidine and clonidine similarly as revealed by the insignificant p value of &gt;0.05 across the time points during hypospadias repair surgeries.Requirement of adjuvant analgesics intraoperativery and post operative complicationsand was found to be similar in both the groups as revealed by the insignificant P value of 0.309. Time for rescue analgesic postoperatively (min) was significantly (p&lt;0.001) longer among patients receiving dexmedetomidine (706.73±107.428) than clonidine (504.33±97.573). Conclusion:We observed that a single caudal injection of dexmedetomidine (2µg/kg) added to ropivacaine 0.25% offers an advantage over a similar injection of clonidine (1µg/kg) added to ropivacaine 0.25% for postoperative pain relief in children undergoing hypospadias repair surgeries without increase in post operative complications.

Age-dependent early complications of hypospadias repair: a single institutional experience.

To correlate age at hypospadias repair with early post-operative complications and highlight need for adaptation to post-operative care in older children. Anecdotal evidence suggests boys with delayed surgery for hypospadias suffer increased rates of early post-operative complication. Hence, a retrospective analysis was conducted of all patients undergoing hypospadias repair between March 2019 and 2022. Ninety eight patients were divided into Group A (< 2years of age at first surgery) or Group B (> 2years). While patients in Group A encountered no early post-operative complications, seven in Group B (11%) suffered a range of complications including dislodged stents (3/7), significant spasmodic pain requiring prolonged hospital stay (2/7) and urinary retention (2/7). More than half of these children required emergency supra-pubic catheter insertion. Significantly more children undergoing hypospadias surgery after the age of 2years suffered complications within the early post-operative period. This resulted in prolonged hospital stays and a number returning to theatre for insertion of a supra-pubic catheter. We recommend a tailored approach to the post-operative care of older children undergoing hypospadias repair, including strict parental education regarding dressing/stent care and medication compliance, as well as efforts to enhance robustness of dressings and stent anchorage in children likely to pull at stents.

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

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 &amp;lt; 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&amp;gt;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 &amp;lt; 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 &amp;lt; 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.

Caudal versus intravenous ketamine for supplementation of analgesia in children undergoing hypospadias repair

Background Different additives have been reported to prolong the duration of caudal anesthesia in pediatrics. Although these drugs successfully increased the duration of the block, ketamine has been found to effectively increase the duration of caudal block in pediatrics. Aim This study aimed to assess the clinical effectiveness of ketamine after caudal or intravenous administration in pediatric patients who underwent hypospadias repair to distinguish between local and systemic analgesia. Patients and methods After induction of general anesthesia, 48 patients, aged 1–6 years, assigned to undergo hypospadias repair, received a caudal injection of bupivacaine and were randomly blinded into two groups: K1 group received 1 mg/kg S-ketamine as the caudal group, and K2 group received 1 mg/kg S-ketamine as the intravenous group. Postsurgical measurements included the effectiveness of postsurgical analgesia, which was assessed by using observational pain scale, duration of analgesia, sedation score, and hemodynamic and complications. Results The caudal block was successful in all the patients included in the study. None of the patients in either groups required intraoperative rescue analgesia. All patients remained vitally stable during the procedure, and intraoperative hemodynamic parameters were comparable in the two groups. The time to the administration of first analgesia was statistically longer in K1 group (11.5±4.6 h) than in the K2 group (8.7±3.1 h). Time to spontaneous leg movement and time to first micturition were statistically nonsignificant between both groups. The number of patients requested for additional analgesic drugs (acetaminophen and ibuprofen) was statistically significant, being higher in the K2 group than the K1 group. Conclusion This study demonstrates that ketamine if added to caudal epidural in a dose of 1 mg/kg provided prolonged postoperative analgesia with improved quality, had longer duration of analgesia, decreased the supplemental acetaminophen analgesia during the first 24 h postoperatively, had stable hemodynamic changes, and had comparable adverse effects and complications in comparison with systemic ketamine in a dose of 1 mg/kg.

Caudal block versus Penile block for postoperative ‎analgesia in children undergoing hypospadias repair

ABSTRACT Background: Caudal block is recommended for analgesia during and after hypospadias repair operation of the penis in children. Aim of the Study: Compare the effectiveness of caudal block vs. dorsal penile block in children undergoing hypospadias repair surgery with respect to postoperative analgesia and appeal for rescue analgesics during the first 24hours. ‎ Patients and Methods: ‎ The study was conducted on 40 male children, ASA I-II, 4-8 years of age undergoing hypospadias repair surgery under general anesthesia. Children were randomly classified into two groups: (Group P) (penile group=20 patients) received a penile block of 2mL bupivacaine 0.25 per cent on each side, (Group C) (caudal block group=20 patients) with a caudal block of 0.25 per cent (1mg / kg) bupivacaine on each side. Postoperative pain assessment will be conducted by mCHEOPS) Children's Hospital of Eastern Ontario Pain Scale (request for rescue analgesic and complete analgesic dosage (mg.). Results: The PACU mCHEOPS pain score was lower in Group C at 2 hrs, 4 hrs and 6 hrs postoperative. Also, the time for the first need for rescue analgesia was statistically significantly lower in group C. The overall analgesic rescue requirement in Group C was also significantly lower. Conclusions: Caudal block tended to be more effective in lowering postoperative pain scores and decreasing the need for rescue analgesia. Key Words: Caudal block, Penile block, Bupivacaine, Hypospadias repair.

Intravenous Dexamethasone Prolongs the Analgesic Effect of Caudal Bupivacaine after Hypospadias Repair Surgery

Background: Dexamethasone has a powerful anti-inflammatory action and has been demonstrated to reduce morbidity after surgery. Objective: The aim of this study was to examine the effects of a single i.v. dose of dexamethasone in combination with caudal block on postoperative analgesia in children. Patients and methods: Sixty pediatric patients (aged 2-10 years) undergoing hypospadias repair surgery were included in this prospective, randomized, double-blinded study at Sohag University Hospital. After induction of general anaesthesia, children received either dexamethasone 0.5 mg ∕ kg (maximum 10 mg) (n=30) or the same volume of saline (n=30) i.v. A caudal anaesthetic block was then performed using 1 ml ∕kg of bupivacaine 0.25% in all patients. Results: After surgery, rescue analgesic consumption, pain scores, and adverse effects were evaluated for 24 h. The time to first administration of acetaminophen (rescue analgesia) was significantly longer in the dexamethasone group (11.35 ± 2.36 hr vs 8.75 ± 1.33 hr) with a significant value of 0.01. Total amount of the analgesia required (paracetamol) was significantly lower in dexamethasone plus caudal block group than the caudal block alone (430 mg vs 680 mg) respectively. Conclusion: Postoperative pain scores were lower in the dexamethasone group and the incidence of adverse effects was similar in both groups. Intravenous dexamethasone 0.5 mg ∕ kg in combination with a caudal block augmented the intensity and duration of postoperative analgesia without adverse effects in children undergoing hypospadias repair surgery.

Intravenous Dexamethasone Prolongs the Analgesic Effect of Caudal Bupivacaine after Hypospadias Repair Surgery

Background: Dexamethasone has a powerful anti-inflammatory action and has been demonstrated to reduce morbidity after surgery. Objective: The aim of this study was to examine the effects of a single i.v. dose of dexamethasone in combination with caudal block on postoperative analgesia in children. Patients and methods: Sixty pediatric patients (aged 2-10 years) undergoing hypospadias repair surgery were included in this prospective, randomized, double-blinded study at Sohag University Hospital. After induction of general anaesthesia, children received either dexamethasone 0.5 mg ∕ kg (maximum 10 mg) (n=30) or the same volume of saline (n=30) i.v. A caudal anaesthetic block was then performed using 1 ml ∕kg of bupivacaine 0.25% in all patients. Results: After surgery, rescue analgesic consumption, pain scores, and adverse effects were evaluated for 24 h. The time to first administration of acetaminophen (rescue analgesia) was significantly longer in the dexamethasone group (11.35 ± 2.36 hr vs 8.75 ± 1.33 hr) with a significant value of 0.01. Total amount of the analgesia required (paracetamol) was significantly lower in dexamethasone plus caudal block group than the caudal block alone (430 mg vs 680 mg) respectively. Conclusion: Postoperative pain scores were lower in the dexamethasone group and the incidence of adverse effects was similar in both groups. Intravenous dexamethasone 0.5 mg ∕ kg in combination with a caudal block augmented the intensity and duration of postoperative analgesia without adverse effects in children undergoing hypospadias repair surgery.

Caudal block versus penile block for postoperative analgesia in children undergoing hypospadias repair

Abstract Background Hypospadias repair is one of the most frequently performed surgical procedures in the pediatric population. Using optimal analgesic regimen provides safe and effective analgesia, reduce postoperative stress response and accelerate recovery from surgery. Aim of the Work The aim of this work is to evaluate the success rate and the effectiveness of penile block for hypospadias repair in pediatric patients in comparison with caudal block. Patients and Methods This prospective randomized study was conducted in Ain Shams University Hospitals; Pediatric Surgery Unit. It included 80 ASA I or II patients undergoing hypospadias (distal penile and mid penile) repair. They were divided into two groups: Group P: Group P penile block (n = 40) received dorsal penile nerve block by using the subpubic approach technique. Group C: Group C caudal block (n = 40) received caudal epidural block using a 22-G needle in the lateral decubitus position. Results There was no statistically significant difference between two groups regarding haemodynamics including MBP (P &amp;lt; 0.05) and HR (P &amp;lt; 0.05). FLACC pain scores were significantly lower in group C compared with group P (P&amp;lt; 0.01). Also, the time to first need for analgesia was significantly lower in group C compared with group P (P&amp;lt; 0.001) .The total rescue analgesic requirement was also significantly lower (P&amp;lt; 0.001) in group C compared with group P.Postoperative time of ambulation was also significantly lower (P&amp;lt; 0.05) in group P compared with group C. Conclusion the current study revealed that caudal block provided significantly prolonged postoperative analgesia, reduced the postoperative analgesic requirements and prolonged time of ambulation as compared with penile block in pediatric patients undergoing hypospadias repair.

Effect of anesthesia for hypospadias repair on perioperative complications.

Recent publications from the United States, India, and Korea report that children undergoing hypospadias repair with caudal regional anesthesia/analgesia could have increased postoperative surgical complications. The purpose of this retrospective cohort study was to assess the impact between caudal regional anesthesia, other regional anesthesia, and no regional anesthesia on complications after hypospadias repair at a tertiary care children's hospital in Ottawa, Canada, with an expectation to changing practices if a link was found. We reviewed the health records of 827 children with hypospadias undergoing penile surgery from January 1991-June 2017. The final sample size for the analysis consisted of 764 patients and 825 procedures. The overall complications were almost identical when considering anesthesia effects, and this similarity persisted when we assessed specifically for only surgical complications. We had 716, 94, and 15 subjects who had a caudal block, penile block, and general anesthesia only, respectively, and their complication rates were 28, 31, and 27%, respectively, and their fistula formation rates were 10, 6, and 0%, respectively, and their stricture formation rates were 8, 7, and 20%,, respectively. Hypospadias type and surgical repair technique were marked predictors of complications in the postoperative period. Anesthesia technique appears to have minor impact on complications after hypospadias repair, while surgical technique and type of hypospadias impact complications after hypospadias surgery in children. Based upon these results, we will not change our current practice of using a variety of regional anesthesia techniques for children undergoing hypospadias repair.

Analgesic efficacy and impact of caudal block on surgical complications of hypospadias repair: a systematic review and meta-analysis

Background and objectivesis commonly used for children undergoing hypospadias repair. However, the safety of caudal block for hypospadias repair in children is controversial in terms of surgical complications such as...

Postoperative behavioral changes in Chinese children undergoing hypospadias repair surgery: A prospective cohort study.

The perioperative period can be psychologically challenging, and children may exhibit behavioral changes following surgical anesthesia. It is unknown whether children in China have additional risk factors associated with negative behavioral changes. The aim of this study was to investigate the incidence of behavioral changes in children after hypospadias repair surgery and to identify potential risk factors associated with negative behavioral changes. A prospective cohort of 177 children aged 2-12years scheduled for hypospadias repair surgery from 2016 to 2017 was studied. The primary outcome was the incidence of behavioral changes on postoperative days 14 and 30 evaluated with the Post-Hospitalization Behavioral Questionnaire. Data collected included demographic data, anesthesia details, procedure details, admission details, child anxiety, child temperament, pain, and emergence delirium. Multivariable logistic regression was used to identify risk factors associated with postoperative negative behavioral changes. A total of 60.5% (107/177) of children exhibited negative postoperative behavioral changes on day 14 and 46.5% (79/170) exhibited changes on day 30 after the surgery. Approximately 2.3% (4/177) and 2.4% (4/170) of children showed improved behavior on postoperative days 14 and 30, respectively. The frequency of temper tantrums changed the most. The logistic regression results suggested that a younger age (odds ratio: 0.86; 95% confidence interval 0.76-0.96), emotional temperament (odds ratio: 1.1; 95% confidence interval 1.0-1.2) and maternal education (odds ratio: 2.2; 95% confidence interval 1.1-4.5) were associated with negative postoperative behavioral changes on day 14. On day 30, a younger age (odds ratio: 0.87; 95% confidence interval 0.77 to 0.98) was the only factor associated with negative postoperative behavioral changes. For children undergoing hypospadias repair surgery in our institution, approximately three in five showed postoperative behavioral changes. In addition to a younger age and a higher maternal education, an emotional temperament is associated with a high incidence of negative postoperative behavioral changes.

Combination of clonidine–bupivacaine in caudal epidural anesthesia for hypospadias surgery in children: prospective, randomized, blind study

Background and objectivesThe combination of clonidine with local anesthetic administered for epidural anesthesia via caudal route seems to improve the quality of postoperative analgesia, but with conflicting results. This study compared the postoperative analgesia of three different doses of clonidine combined with bupivacaine in caudal epidural anesthesia in children undergoing hypospadias repair. MethodsEighty children aged 1–10 years, candidates for surgical repair of hypospadias, were randomly divided into four groups of 20 patients to receive general anesthesia combined with caudal epidural anesthesia with bupivacaine 0.165% alone or in combination with 1, 2 or 3μg.kg−1 of clonidine. The primary outcome was morphine consumption in the first 24h postoperatively. Mean arterial pressure, heart rate, end-tidal concentration of sevoflurane, time to awakening, pain severity (FLACC scale), level of sedation (RAMSAY), duration of analgesia, and occurrence of adverse effects were also compared. ResultsIntraoperatively, there was no difference between groups regarding mean arterial pressure, heart rate, end-tidal concentration of sevoflurane, and time to awakening. Postoperative morphine consumption and pain severity were similar between groups, but the group receiving clonidine (3μg.kg−1) had lower heart rate and higher sedation level than the group receiving bupivacaine alone. ConclusionsThe combination of clonidine at doses of 1, 2 or 3μg.kg−1 with bupivacaine 0.16% via caudal epidural route did not alter the consumption of morphine in the early postoperative period of children undergoing hypospadias repair.

Associação clonidina‐bupivacaína na anestesia peridural caudal para cirurgia de hipospádia em crianças: estudo prospectivo, randomizado, encoberto

Background and objectivesThe combination of clonidine with local anesthetic administered for epidural anesthesia via caudal route seems to improve the quality of postoperative analgesia, but with conflicting results. This study compared the postoperative analgesia of three different doses of clonidine combined with bupivacaine in caudal epidural anesthesia in children undergoing hypospadias repair. MethodsEighty children aged 1 to 10 years, candidates for surgical repair of hypospadias, were randomly divided into four groups of 20 patients to receive general anesthesia combined with caudal epidural anesthesia with bupivacaine 0.165% alone or in combination with 1, 2 or 3μg.kg‐1 of clonidine. The primary outcome was morphine consumption in the first 24hours postoperatively. Mean arterial pressure, heart rate, end‐tidal concentration of sevoflurane, time to awakening, pain severity (FLACC scale), level of sedation (RAMSAY), duration of analgesia, and occurrence of adverse effects were also compared. ResultsIntraoperatively, there was no difference between groups regarding mean arterial pressure, heart rate, end‐tidal concentration of sevoflurane, and time to awakening. Postoperative morphine consumption and pain severity were similar between groups, but the group receiving clonidine (3μg.kg‐1) had lower heart rate and higher sedation level than the group receiving bupivacaine alone. ConclusionsThe combination of clonidine at doses of 1, 2 or 3μg.kg‐1 with bupivacaine 0.16% via caudal epidural route did not alter the consumption of morphine in the early postoperative period of children undergoing hypospadias repair.

Effect of Preoperative Instructions for Mothers on Selected Postoperative Outcomes Among their Children with Hypospadias

Abstract Background: Hypospadias is the most common birth defect among children affecting the penis characterized by ventral position of urethral meatus in which caused by arrest of normal development of the urethra.Aim of Study: To evaluate the effect of preoperative instructions for mothers on selected postoperative outcomes among their children with hypospadias.Subjects and Methods: A quasi-experimental research design (Pre-Posttest) was used to achieve the aim of the current study. A convenient sample of 60 mothers having male children undergoing surgical repair of hypospadias participated in the current study, divided into two equal groups: 30 as a control group and 30 as a study group who were subject to the preoperative instructions. The setting was in-patient pediatric surgical department at Cairo University Specialized Pediatric Hospital (CUSPH). The required data was collected through: 1- Structured interview (questionnaire); 2- Mothers' knowledge and reported practice assessment sheet (pre-posttest) and 3- Postoperative outcomes assessment record. Results: The study's results revealed that, children in the study group exposed to less early postoperative complications such as (bleeding, wound dehiscence, urinary obstruction and urinary catheter fall) than children in the control group. Late postoperative complications (fistula, meatal stenosis, urethral obstruction and infection) occurred in children in the study group less than those in the control group. Children in the study group had appropriate cosmetic appearance of the penis and functional outcome than children in the control group.Conclusion: The current study concluded that children whom mothers received the preoperative instructions about hypospadias had improved outcomes in relation to less com-plications, higher cosmetic and functional outcomes than children in the control group. Recommendation: It was rec-ommended that provision of pre and post-operative care of children undergoing hypospadias repair is mandatory to achieve satisfactory postoperative outcomes.

The association between caudal anesthesia and increased risk of postoperative surgical complications in boys undergoing hypospadias repair.

Recent reports have suggested that caudal anesthesia may be associated with an increased risk of postoperative surgical complications. We examined our experience with caudal anesthesia in hypospadias repair to evaluate for increased risk of urethrocutaneous fistula or glanular dehiscence. All hypospadias repairs performed by a single surgeon in 2001-2014 were reviewed. Staged or revision surgeries were excluded. Patient age, weight, hypospadias severity, surgery duration, month and year of surgery, caudal anesthesia use, and postoperative complications were recorded. Bivariate and multivariate statistical analyses were performed. We identified 395 single-stage primary hypospadias repairs. Mean age was 15.6 months; 326 patients had distal (83%) and 69 had proximal (17%) hypospadias. Caudal anesthetics were used in 230 (58%) cases; 165 patients (42%) underwent local penile block at the discretion of the surgeon and/or anesthesiologist. Complications of urethrocutaneous fistula or glanular deshiscence occurred in 22 patients (5.6%) and were associated with caudal anesthetic use (OR 16.5, 95% CI 2.2-123.8, P = 0.007), proximal hypospadias (OR 8.2, 95% CI 3.3-20.0, P < 0.001), increased surgical duration (OR 1.01, 95% CI 1.01-1.02, P < 0.001), and earlier year of practice (OR 3.0, 95% CI 1.2-7.9, P = 0.03 for trend). After adjusting for confounding variables via multivariable logistic regression, both caudal anesthetic use (OR 13.4, 95% CI 1.8-101.8, P = 0.01) and proximal hypospadias (OR 6.8, 95% CI 2.7-16.9, P < 0.001) remained highly associated with postoperative complications. In our experience, caudal anesthesia was associated with an over 13-fold increase in the odds of developing postoperative surgical complications in boys undergoing hypospadias repair even after adjusting for urethral meatus location. Until further investigation occurs, clinicians should carefully consider the use of caudal anesthesia for children undergoing hypospadias repair.

To tell or not: parental thoughts on disclosure of urologic surgery to their child.

ABSTRACTPurpose:Literature pertaining to surgical disclosure to the pediatric patient is lacking. We hypothesized parents would find it difficult to disclose urologic surgery to a child.Materials and Methods:Parents of patients <5 years old undergoing urologic surgery were contacted for telephone survey. Parents were asked about future plans of surgical disclosure, comfort with disclosure, and any support received.Results:98 parents consented to study participation. 87% of surgeries were on the genitalia with 62% being minor genitalia surgery (i.e. circumcision). 70% of parents would tell their child about minor genital surgery while 84% would tell about major genital surgery (p=0.07). 4 of 20 parents of children undergoing hypospadias repair (major genital surgery) did not plan to tell their child about surgery. All parents of children undergoing non-genital surgery would tell. Of all parents planning to tell their children about surgery, only 14% were nervous. 34% of parents would find guidance in talking to their child helpful despite the majority (90%) stating no guidance had ever been provided.Conclusions:Parents seem comfortable discussing urologic surgeries with a child but about 1/3 would appreciate further counseling. 20% of parents of children undergoing hypospadias repair hope to avoid telling their child.