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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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.