Hecht Sarah, Piñeda Jorge, Bayne Aaron
Division of Pediatric Urology, Doernbecher Children's Hospital, Portland, OR.
Division of Pediatric Anesthesiology, Doernbecher Children's Hospital, Portland, OR.
Urology. 2018 Mar;113:192-196. doi: 10.1016/j.urology.2017.11.006. Epub 2017 Nov 16.
To evaluate pudendal nerve block as an alternative to caudal block for hypospadias surgery.
Data were obtained by chart review. Children who underwent hypospadias repair between 2012 and 2016 by a single surgeon at an academic institution were included. Patients received ultrasound-guided pudendal block (n = 21) or caudal block (n = 19) as a regional adjunct to general anesthesia. Primary outcomes included analgesic requirement and postoperative length of stay in the recovery unit.
The pudendal block cohort was slightly older (27.6 vs 18.5 months, P = .017) and had more severe hypospadias than the caudal block cohort (53% vs 35% proximal hypospadias, respectively). We detected no statistically significant difference in intraoperative opioid, postoperative opioid, or nonopioid analgesic requirement (17.9 vs 12.9 mcg fentanyl, P = .267; 0.3 vs 0.3 doses, P = .92; 0.2 vs 0.1 doses, P = .46, respectively). Postoperative length of stay was significantly shorter in the pudendal block cohort (96 vs 128 minutes, P = .016).
We are the first to report the use of ultrasound-guided pudendal block for hypospadias repair. This appears to be a safe and effective alternative to caudal block with no perioperative delays. Pudendal block has several advantages over caudal block. It avoids the risks of urinary retention and lower extremity weakness and can be administered to older patients and children with spinal anomalies.
Compared with caudal block, ultrasound-guided pudendal nerve block is safe, provides equivalent pain control for hypospadias repair, and results in a shorter time to discharge.
评估阴部神经阻滞作为尿道下裂手术中骶管阻滞替代方法的效果。
通过查阅病历获取数据。纳入2012年至2016年间在一所学术机构由同一位外科医生进行尿道下裂修复手术的儿童。患者接受超声引导下阴部阻滞（n = 21）或骶管阻滞（n = 19）作为全身麻醉的区域辅助。主要结局包括镇痛需求和术后在恢复室的住院时间。
阴部阻滞组患儿年龄稍大（27.6个月对18.5个月，P = 0.017），且尿道下裂比骶管阻滞组更严重（近端尿道下裂分别为53%对35%）。我们未发现术中阿片类药物、术后阿片类药物或非阿片类镇痛需求有统计学显著差异（分别为17.9对12.9微克芬太尼，P = 0.267；0.3对0.3剂，P = 0.92；0.2对0.1剂，P = 0.46）。阴部阻滞组术后住院时间显著更短（96分钟对128分钟，P = 0.016）。
我们是首个报道将超声引导下阴部阻滞用于尿道下裂修复手术的。这似乎是一种安全有效的骶管阻滞替代方法，且无围手术期延迟。阴部阻滞比骶管阻滞有几个优势。它避免了尿潴留和下肢无力的风险，并且可用于年龄较大的患者和有脊柱异常的儿童。
与骶管阻滞相比，超声引导下阴部神经阻滞是安全的，为尿道下裂修复提供同等的疼痛控制，且出院时间更短。
