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Pudendal Versus Caudal Block in Children Undergoing Hypospadias Surgery: A Randomized Controlled Trial
  1. Pinar Kendigelen, MD*,
  2. Ayse Cigdem Tutuncu, MD*,
  3. Senol Emre, MD,
  4. Fatis Altindas, MD* and
  5. Guner Kaya, MD*
  1. From the Departments of *Anesthesiology and Intensive Care, and †Pediatric Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
  1. Address correspondence to: Pinar Kendigelen, MD, Department of Anesthesiology and Intensive Care, Cerrahpasa Medical Faculty, Istanbul University, Kocamustafapasa St, No. 53 Fatih, 34098 Istanbul, Turkey (e-mail:


Background and Objectives Postoperative pain management after hypospadias surgery is often challenging. Caudal block is used for analgesia but has limitations. This study compares the analgesic efficiency of pudendal block with that of caudal block in pediatric patients undergoing hypospadias repair surgery.

Methods This prospective, double-blind, randomized, controlled study enrolled 84 patients receiving pudendal block or caudal block before hypospadias surgery. In the pudendal group, the pudendal nerve was identified using a nerve stimulator, and the block consisted of 0.25% bupivacaine 0.5 mL/kg. In the caudal group, the caudal block used 0.2% bupivacaine 1 mL/kg. Our primary outcome was pain intensity within 24 hours postoperatively. The trial was registered at (number: NCT02390388).

Results For the primary outcome, patients in the pudendal group had lower postoperative pain intensity when compared with the caudal group (P < 0.001). Three patients in the pudendal group and all of the patients in the caudal group needed additional analgesia within 24 hours after the surgery (P < 0.001). The family satisfaction rate was significantly higher in the pudendal group (P < 0.001).

Conclusions For the pudendal group, the pain scores for the first 24 hours after the surgery were significantly lower and the duration of analgesia was longer.

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  • The authors declare no conflict of interest.