Optimizing Paediatric Hypospadias Surgical Repair: Pudendal Nerve Block Versus Caudal Block for Superior Analgesia.

Objective: Postoperative pain control after hypospadias surgery can be challenging, and the effectiveness of caudal block (CB) for analgesia is limited. This study evaluated the analgesic efficacy of pudendal nerve block (PNB) using both ultrasound and a peripheral nerve stimulator (PNS), compared to a CB performed using landmark guidance, in paediatric patients undergoing hypospadias surgical repair.

Methods: A total of 40 patients scheduled for hypospadias surgery were included in this prospective, randomized, double-blind controlled trial, who received either a PNB or a CB. Patients in the pudendal group received an ultrasound- and PNS-guided, PNB with a combination of bupivacaine (0.25%) at a dose of 0.5 mL kg^-1 and clonidine at a dose of 1 μg kg^-1, whereas those in the caudal group received a landmark-guided CB with bupivacaine (0.25%) at a dose of 1 mL kg^-1 along with clonidine at a dose of 1 μg kg^-1. The objective pain scale (OPS) was used to assess pain intensity in each group within 24 hours post-surgery. Perioperative hemodynamic changes and analgesic requirements were also recorded.

Results: The CB provided effective analgesia, lasting an average of 6 hours. OPS scores at 6, 12, 18, and 24 hours after surgery were significantly lower in the PNB group than in the CB group. The PNB group had a significantly longer time to the need for initial analgesia, while the CB group required a significantly greater dose of paracetamol after surgery (P < 0.001).

Conclusion: Findings from this study suggest that, at these doses, PNB is more effective than CB in providing longer-lasting pain relief, significantly lower pain scores, and a reduced need for postoperative analgesics.