Background and Aims Caudal block is one of the most preferred regional anaesthesia methods in paediatric population, but its use is associated with potentially serious complications. Pudendal nerve block is an efficient alternative of caudal analgesia for perineal procedures. The aim of this study is to evaluate the efficacy of ultrasound-guided transperineal pudendal nerve block with respect to ultrasound-guided caudal block for perineal surgeries in children.

Methods Sixty children aged 1–12 years having physical status of ASA grade I-II and posted for elective perineal surgeries were included in the study. Patients were randomly assigned to receive ultrasound-guided caudal block(Group-C) or pudendal nerve block (Group-P) with 0.25% bupivacaine. Duration of analgesia, block performance time, first puncture success, FLACC/VAS scores and PADSS score was recorded for each patient.

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Abstract B47 Figure 1

Results Time to perform pudendal block was significantly more (17.2±2.4 vs 10.5±2.4 min, P<0.001) and success rate for block was less as compared to caudal block (83% vs 90%). The mean FLACC and VAS pain scores were comparable. The mean first rescue analgesia time was more in group-P (1035.3 ±174.8 vs 247.5±101.1 min, P<0.0001). The mean dose of postoperative diclofenac required(13.0 ±19.5 vs 3.33±8.0mg, p=0.014) and time to reach PADSS score of 9 (21.4±3 vs 14.9±4.8 hours, P<0.0001) was significantly more in Group-C.

Conclusions Ultrasound guided Pudendal nerve block provided a longer duration of analgesia, lower pain scores and resulted in faster readiness to discharge in children undergoing perineal surgery. We recommended wider adoption of this technique for perineal procedures in children.