Pudendal nerve block provides better analgesia in the first 24 hours for children following hypospadias repair than does caudal block.

pearl

• Zoher M Naja, Fouad M Ziade, Raymond Kamel, Sabah El-Kayali, Nabil Daoud, and Mariam A El-Rajab.
• From the *Anesthesia and Pain Management Department, Makassed General Hospital; †Health and Environmental Science Department, Faculty of Public Health, Lebanese University; ‡Chief of Division of General Pediatrics, Pediatrics Department, Saint George Hospital University Medical Center, Beirut, Lebanon; and §Anesthesia Department, Mowasat University Hospital, Damascus, Syria; and ‖Pediatrics Department, Makassed General Hospital, Beirut, Lebanon.
• Anesth. Analg.. 2013 Dec 1;117(6):1401-7.

BackgroundCaudal block (CB) has some disadvantages, one of which is its short duration of action after a single injection. For hypospadias repair, pudendal nerve block (PNB) might be a suitable alternative since it has been successfully used for analgesia for circumcision. We evaluated PNB compared with CB as measured by total analgesic consumption 24 hours postoperatively.MethodsIn this prospective, double-blinded study, patients were randomized into 2 groups, either receiving CB or nerve stimulator-guided PNB. In the PNB group, patients were injected with 0.3 mL/kg 0.25% bupivacaine and 1 µg/kg clonidine. In the CB group, patients were injected with 1 mL/kg 0.25% bupivacaine and 1 µg/kg clonidine. Analgesic consumption was assessed during the first 24 hours postoperatively. The "objective pain scale" developed by Hannalah and Broadman was used to assess postoperative pain.ResultsEighty patients participated in the study, 40 in each group. The mean age in the PNB group was 3.1 (1.1) years and in the CB group was 3.2 (1.1) years. The mean weights in the PNB and CB groups were 15.3 (2.8) kg and 15.3 (2.2) kg, respectively. The percentage of patients who received analgesics during the first 24 hours were significantly higher in the CB (70%) compared with the PNB group (20%, P < 0.0001). The average amount of analgesics consumed per patient within 24 hours postoperatively was higher in the CB group (paracetamol P < 0.0001, Tramal P =0.003).ConclusionPatients who received PNB had reduced analgesic consumption and pain within the first 24 hours postoperatively compared with CB.

38 keywords...

hide…