A Comparison of the Ultrasound-Guided Dorsal Penile Block and Ultrasound-Guided Caudal Epidural Block for Postoperative Analgesia in Children Undergoing Hypospadias Surgery: A Randomized Controlled Study.

INTRODUCTION

Hypospadias repair is a common pediatric surgical procedure. While caudal epidural block (CB) is the standard analgesic technique, dorsal penile nerve block (DB) serves as a viable alternative. This study evaluated and compared the postoperative analgesic effectiveness of CB and DB in children undergoing hypospadias repair.

METHODS

A total of 60 children aged one to six years undergoing hypospadias surgery were randomly assigned to either Group CB (ultrasound-guided caudal epidural block) or Group DB (ultrasound-guided dorsal penile block). The primary objective was to assess the time to first rescue analgesia, while the secondary objectives included evaluating postoperative pain using the Face, Legs, Activity, Cry and Consolability (FLACC) scale, postoperative analgesic requirements, and potential adverse effects such as hypotension, urinary retention, and respiratory depression.

RESULTS

The time to first rescue analgesia was significantly longer in Group DB compared to Group CB (20.90 ± 6.49 vs. 11.48 ± 6.13 hours, p<0.001). Rescue analgesia requirement was significantly higher in Group CB (96.7%) than in Group DB (23.3%) within 24 hours (p<0.001). The average FLACC score was significantly higher in Group CB compared to Group DB (0.72 ± 0.29 vs. 0.25 ± 0.22, p<0.001). No complications were observed in either group.

CONCLUSION

Ultrasound-guided dorsal penile block proved more effective than caudal epidural block for postoperative pain management in hypospadias surgery, leading to longer time to first analgesic administration, lower pain scores, and reduced rescue analgesic requirements. Further studies are required to validate these findings.