Comparison of regional anesthesia techniques for hypospadias surgery: A systematic review

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-02-28 DOI:10.1016/j.jclinane.2025.111792

Hiroki Nakamura MD , Kensuke Shimada MD, MPH , Masao Iwagami MD, PhD , Tatsuhiko Masue MD, PhD , Nanako Tamiya MD, MSc, PhD , Ryota Inokuchi MD, PhD

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引用次数: 0

Abstract

Objectives

Regional anesthesia is commonly used in hypospadias surgery; however, the optimal timing, drugs, and types of blocks remain controversial. Therefore, we conducted a systematic review to identify superior regional-anesthesia techniques for hypospadias surgery.

Methods

This systematic review was registered with the International Prospective Register of Systematic Reviews (CRD42023431583). The following databases were utilized: MEDLINE, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar. We included randomized controlled trials (RCTs) published until June 3, 2023, which evaluated any regional anesthesia method for hypospadias surgery and investigated pain and complications.

Results

This review included 44 RCTs that compared: (i) types of regional anesthesia, (ii) timing of regional anesthesia (before and after surgery), (iii) drugs used, (iv) regional anesthesia with or without additional interventions, and (v) a composite comparison of the above comparisons. In studies comparing types of regional anesthesia, pudendal nerve block was found to be superior for hypospadias surgery compared to other types, including caudal and penile blocks. No advantage was observed in administering regional anesthesia post-surgery compared to pre- or both pre- and post-surgery. However, a meta-analysis was not feasible due to differing pain scales used across studies.

Discussion

The pudendal nerve block could provide better analgesia than other regional anesthesia methods in terms of pain scales and analgesia duration. Regional anesthesia administered before or both pre- and post-surgery may be more effective than that post-surgery based on pain scales and analgesia duration. A standardized pediatric pain scale is warranted to unify study results.

PROSPERO ID: CRD42023431583.

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尿道下裂手术区域麻醉技术的比较：系统综述

目的局部麻醉是尿道下裂手术中常用的麻醉方法；然而，阻滞的最佳时机、药物和类型仍然存在争议。因此，我们进行了一项系统综述，以确定尿道下裂手术的优越区域麻醉技术。方法本系统评价已在国际前瞻性系统评价注册号（CRD42023431583）注册。使用以下数据库：MEDLINE、Embase、Web of Science、Cochrane Central Register of Controlled Trials和谷歌Scholar。我们纳入了截至2023年6月3日发表的随机对照试验（RCTs），这些试验评估了尿道下裂手术的任何区域麻醉方法，并调查了疼痛和并发症。结果本综述纳入44项随机对照试验，比较：(i)区域麻醉的类型，（ii）区域麻醉的时间（术前和术后），（iii）使用的药物，（iv）有或没有额外干预的区域麻醉，以及(v)上述比较的综合比较。在比较区域麻醉类型的研究中，发现阴部神经阻滞优于其他类型的尿道下裂手术，包括尾侧阻滞和阴茎阻滞。与术前或术前和术后相比，术后给予区域麻醉没有任何优势。然而，由于不同研究中使用的疼痛量表不同，荟萃分析是不可行的。讨论阴部神经阻滞在疼痛程度和镇痛持续时间方面优于其他区域麻醉。根据疼痛程度和镇痛持续时间的不同，手术前或手术前后进行区域麻醉可能比手术后更有效。一个标准化的儿童疼痛量表是必要的，以统一研究结果。普洛斯彼罗id: crd42023431583。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.