Ozen Volkan, Yigit Dogakan
Prof.Dr. Cemil Tascioglu City Hospital, Department of Anesthesiology and Reanimation. Kaptan Paşa, SSK Okmeydanı Hst. No:25, 34384, Şişli, İstanbul, Turkey.
Prof.Dr. Cemil Tascioglu City Hospital, Department of Pediatric Surgery, Kaptan Paşa, SSK Okmeydanı Hst. No:25, 34384, Şişli, İstanbul, Turkey.
J Pediatr Urol. 2020 Aug;16(4):438.e1-438.e8. doi: 10.1016/j.jpurol.2020.05.009. Epub 2020 May 20.
The surgery of hypospadias is very painful in the postoperative period and requires long-term analgesia. A dorsal penile nerve block (DPNB) and caudal epidural block (CEB) are commonly used regional anesthesia techniques for postoperative pain control.
The primary aim of the prospective, observational study was to use the duration until the first postoperative analgesic requirement after two different block techniques to compare the analgesic effect. The secondary aims were to compare the two methods for postoperative Children's Hospital Eastern Ontario Pain Scale (CHEOPS) scores, complications and parental satisfaction level.
This study was conducted with male patients aged 1-5 years in the ASA I-II group, who were scheduled for hypospadias surgery. A CEB or ultrasound (US)-guided DPNB with the in-plane technique was administered under general anesthesia before the operation. Postoperative analgesic need, postoperative pain, complications and parental satisfaction were noted. STROBE checklist was followed for reporting.
The study was conducted with 26 patients in total, divided into 13 patients receiving CEB and 13 patients receiving DPNB. The mean CHEOPS score (p = 0.003) and 12th hour CHEOPS score (p = 0.003) were statistically significantly higher in the CEB group than the DPNB group. The need for additional postoperative analgesia was higher in the CEB group than the DPNB group (p < 0.001). No complications were seen in two groups.
Dorsal penile nerve block with the US-guided in-plane technique provided effective and long-lasting postoperative analgesia for hypospadias surgery.
The postoperative analgesia was better with DPNB than with CEB in hypospadias surgery, particularly in the first 12 h. Parental satisfaction was higher with DPNB thanks to the minimum postoperative analgesia requirement and lack of complications. CLINICALTRIALS.
NCT04215874.
尿道下裂手术在术后阶段非常疼痛，需要长期镇痛。阴茎背神经阻滞（DPNB）和骶管硬膜外阻滞（CEB）是术后疼痛控制常用的区域麻醉技术。
这项前瞻性观察研究的主要目的是利用两种不同阻滞技术后至首次术后镇痛需求的持续时间来比较镇痛效果。次要目的是比较两种方法在术后安大略东部儿童医院疼痛量表（CHEOPS）评分、并发症及家长满意度方面的差异。
本研究针对年龄在1 - 5岁、ASA I - II级、计划行尿道下裂手术的男性患者进行。在手术前全身麻醉下实施CEB或超声（US）引导下采用平面内技术的DPNB。记录术后镇痛需求、术后疼痛、并发症及家长满意度。报告遵循STROBE清单。
本研究共纳入26例患者，分为接受CEB的13例患者和接受DPNB的13例患者。CEB组的平均CHEOPS评分（p = 0.003）和第12小时CHEOPS评分（p = 0.003）在统计学上显著高于DPNB组。CEB组术后额外镇痛的需求高于DPNB组（p < 0.001）。两组均未观察到并发症。
超声引导下平面内技术的阴茎背神经阻滞为尿道下裂手术提供了有效且持久的术后镇痛。
在尿道下裂手术中，DPNB的术后镇痛效果优于CEB，尤其是在最初12小时。由于术后镇痛需求最小且无并发症，DPNB使家长满意度更高。临床试验。
NCT04215874。
