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Nerve stimulation guided bilateral pudendal nerve block versus landmark-based caudal block for hypospadias repair in young children: a prospective, randomized, pragmatic trial
  1. Dinesh K Choudhry1,
  2. Larry Heredia2,
  3. Bruce Randall Brenn1,3,
  4. Melinda Brown4,
  5. Norman F Carvalho5,
  6. Milicent C Whaley5,
  7. Sadiq S Shaik5,
  8. Jennifer A Hagerty6 and
  9. Ahmad Bani Hani6
  1. 1Department of Anesthesiology, Shriners Hospitals for Children, Philadelphia, Pennsylvania, USA
  2. 2Department of Anesthesiology, St Francis Hospital, Wilmington, Delaware, USA
  3. 3Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennesee, USA
  4. 4Anesthesiology, Nemours Children's Hospital Delaware, Wilmington, Delaware, USA
  5. 5Anesthesiology, Nemours Children's Hospital, Orlando, Florida, USA
  6. 6Urology, Nemours Children's Hospital Delaware, Wilmington, Delaware, USA
  1. Correspondence to Dr Dinesh K Choudhry, Anesthesiology, Shriners Hospitals for Children, Philadelphia, PA 19140, USA; dchoudhry{at}shrinenet.org

Abstract

Introduction Caudal block is frequently performed to provide analgesia for hypospadias repair. Literature suggests that pudendal block provides prolonged postoperative analgesia as compared with caudal block in children between 2 and 5 years. We compared the efficacy of pudendal and caudal blocks in children less than 2 years.

Methods 60 children scheduled for hypospadias repair received standard general anesthesia along with either pudendal or caudal block (groups of 30 each). Variables collected were demographic data, block time, operating room time, intraoperative pain medication need, pain assessment score and medication need in the recovery room and pain assessment at home.

Result Groups were demographically similar. No differences were observed in the following recorded times (minutes): block procedure (caudal: 9.5±4.0, pudendal: 10.6±4.1, p=0.30), anesthesia (caudal: 17.3±5.3, pudendal: 17.7±4.3, p=0.75), total OR (caudal: 171±35, pudendal: 172±41; p=0.95) and postanesthesia care unit (PACU) stay (caudal: 88±37, pudendal: 86±42; p=0.80). Additionally, no differences were observed in rescue pain medication need in the operating room (caudal: 0, pudendal: 2 (p=0.49), in PACU (caudal: 4, pudendal: 4, p=0.99), pain assessed at home, time to pain level 2 (caudal: 13.93±8.9, pudendal: 15.17±8.7), average pain scores (p=0.67) and total pain free epochs (pain level of zero) (p=0.80) in the first 24 hours.

Discussion In children less than 2 years, both blocks provide comparable intraoperative and postoperative pain relief in the first 24 hours after hypospadias surgery.

Trial registration number NCT03145415.

  • Pediatrics
  • Pain Management
  • Pain, Postoperative
  • Anesthesia, Local
  • Nerve Block

Data availability statement

Data are available on reasonable request. Data are included in the article.

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Data availability statement

Data are available on reasonable request. Data are included in the article.

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Footnotes

  • Contributors DKC: corresponding author. This author helped design the study, perform the study, review the literature, write and revise the manuscript. This author has approved the final version of the manuscript to be published and agrees to be accountable for all aspects of the work to ensure that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. LH: this author helped design the study, enrolled participants, perform the study, review the literature, write and revise the manuscript. This author has approved the final version of the manuscript to be published and agrees to be accountable for all aspects of the work to ensure that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. BRB: this author helped design the study, generate random allocation sequence, do the statistical analysis, review the literature and revise the manuscript. This author has approved the final version of the manuscript to be published and agrees to be accountable for all aspects of the work to ensure that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. MB: this author helped perform the study. This author has approved the final version of the manuscript to be published and agrees to be accountable for all aspects of the work to ensure that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. NC: this author helped perform the study and has approved the final version of the manuscript to be published. MCW: this author helped perform the study and has approved the final version of the manuscript to be published. SSS: this author helped perform the study and has approved the final version of the manuscript to be published. JAH: this author helped enroll patients for the study. This author has approved the final version of the manuscript to be published and agrees to be accountable for all aspects of the work to ensure that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. ABH: this author helped enroll patients for the study. This author has approved the final version of the manuscript to be published and agrees to be accountable for all aspects of the work to ensure that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.