Analgesic efficacy of Ultrasound-Guided Caudal Block versus Pudendal Nerve Block in BRAKA - I Repair for Paediatric Hypospadias
DOI:
https://doi.org/10.51253/pafmj.v74i1.9445Keywords:
Analgesia, Caudal block, Children, Pudendal nerve blockAbstract
Objective: To compare the efficacy of ultrasound-guided caudal versus pudendal nerve block analgesia in paediatric patients undergoing hypospadias.
Study Design: Quasi-experimental study.
Place and Duration of Study: Combined Military Hospital Rawalpindi, Pakistan from Mar to Sep 2022.
Methodology: Paediatric patients with ages ranging from 4-12 years with ASA Grade I/II planned for hypospadias repair
were included. Sixty-eight patients were divided into Group-C (caudal block) and Group-P (pudendal nerve block), after
randomization. Group-C patients received ultrasound-guided caudal block while pudendal nerve blockade was performed
under ultrasound guidance in Group- P. Demographic variables, requirement of rescue analgesics, CHEOPS scoring at 0, 1, 2,6 and 12 hours, and complications in the intraoperative period were recorded.
Results: Pain scores at the 6th and 12th hour were significantly reduced in Group-P compared to Group-C. Requirement of
analgesia was lesser in Group P 01(2.9%) compared to 11(32.3%) in Group C with a p-value of 0.006. Out of 34 patients in
Group-C 07(20.6%), patients encountered complications compared to Group-P, which had no complications.
Conclusion: Ultrasound-guided pudendal nerve block is superior to caudal block in providing adequate perioperative
analgesia with fewer complications and decreased requirement of additional analgesic supplements.
Downloads
Metrics
References
Ponde V. Recent trends in paediatric regional anaesthesia. Indian J
Anaesth 2019; 63(9): 746-753.
https://doi.org/10.4103/ija.IJA_502_19.
Greaney D, Everett T. Paediatric regional anaesthesia: updates in
central neuraxial techniques and thoracic and abdominal blocks.
BJA Educ 2019; 19(4): 126-134.
https://doi.org/10.1016/j.bjae.2018.12.003.
Kalava A, Pribish AM, Wiegand LR. Pudendal nerve blocks in
men undergoing urethroplasty: a case series. Roman J Anaesth
Intens Care 2017; 24(2): 159-162.
https://doi.org/10.21454/rjaic.7518.242.klv.
Okoro C, Huang H, Cannon S, Low D, Liston DE, Richards MJ,
et al. The pudendal nerve block for ambulatory urology: what’s
old is new again. A quality improvement project. J Pediatr Urol
https://doi.org/10.1016/j.jpurol.2020.07.025.
Guay J, Suresh S, Kopp S. The use of ultrasound guidance for
perioperative neuraxial and peripheral nerve blocks in children.
Cochrane Database Syst Rev 2019; 2019(2): CD011436.
https://doi.org/10.1002/14651858.CD011436.pub3.
Bomberg H, Wetjen L, Wagenpfeil S, Schöpe J, Kessler P, Wulf H,
et al. Risks and Benefits of Ultrasound, Nerve Stimulation, and
Their Combination for Guiding Peripheral Nerve Blocks: A
Retrospective Registry Analysis. Anesth Analg 2018; 127(4):
-1043. https://doi.org/10.1213/ANE.0000000000003480.
Kil HK. Caudal and epidural blocks in infants and small children:
historical perspective and ultrasound-guided approaches.
Korean J Anesthesiol 2018; 71(6): 430-439.
https://doi.org/ 10.4097/kja.d.18.00109.
Ozen V, Yigit D. Caudal epidural block versus ultrasound-guided
dorsal penile nerve block for pediatric distal hypospadias
surgery: A prospective, observational study. J Pediatr Urol 2020;
(4): 438.e1-438.e8.
https://doi.org/ 10.1016/j.jpurol.2020.05.009.
Shamim F, Ullah H, Khan FA. Postoperative pain assessment
using four behavioral scales in Pakistani children undergoing
elective surgery. Saudi J Anaesth 2015; 9(2): 174-178.
https://doi.org/10.4103/1658-354X.152874.
Munevveroglu C, Gunduz M. Postoperative pain management
for circumcision; Comparison of frequently used methods. Pak J
Med Sci 2020; 36(2): 91-95.
https://doi.org/10.12669/pjms.36.2.505.
Dontukurthy S, Tobias JD. Update on Local Anesthetic Toxicity,
Prevention and Treatment During Regional Anesthesia in Infants
and Children. J Pediatr Pharmacol Ther 2021; 26(5): 445-454.
https://doi.org/10.5863/1551-6776-26.5.445.
Ahmed WA, Shokier MH, Kasem AA, El Aziz MH, Saed SG.
Comparative study between ultrasound-guided pudendal nerve
block and caudal epidural block anesthesia in children
undergoing hypospadias surgery. Ain-Shams J Anesthesiol 2021;
: 50. https://doi.org/10.1186/s42077-021-00172-4.
Ozen V. Comparison of the postoperative analgesic effects of USguided caudal block and US-guided pudendal nerve block in
circumcision. Int J Clin Pract 2021; 75(10): e14366.
https://doi.org/10.1111/ijcp.14366.
Jain D, Hussain SY, Ayub A. Comparative evaluation of
landmark technique and ultrasound-guided caudal epidural
injection in pediatric population: A systematic review and metaanalysis. Paediatr Anaesth 2022; 32(1): 35-42.
https://doi.org/10.1111/pan.14332.
Boretsky KR, Camelo C, Waisel DB, Falciola V, Sullivan C,
Brusseau E, et al. Confirmation of success rate of landmark-based
caudal blockade in children using ultrasound: A prospective
analysis. Paediatr Anaesth 2020; 30(6): 671-675.
https://doi.org/10.1111/pan.13865.
Aksu C, Akay MA, Şen MC, Gürkan Y. Ultrasound-guided dorsal
penile nerve block vs neurostimulator-guided pudendal nerve
block in children undergoing hypospadias surgery: A
prospective, randomized, double-blinded trial. Paediatr Anaesth
; 29(10): 1046-1052. https://doi.org/10.1111/pan.13727.
Hecht S, Piñeda J, Bayne A. Ultrasound-guided Pudendal Block
Is a Viable Alternative to Caudal Block for Hypospadias Surgery:
A Single-Surgeon Pilot Study. Urology 2018; 113: 192-196.
https://doi.org/10.1016/j.urology.2017.11.006.
Choudhry DK, Heredia L, Brenn BR, Brown M, Carvalho NF,
Whaley MC, et al. Nerve stimulation guided bilateral pudendal
nerve block versus landmark-based caudal block for
hypospadias repair in young children: a prospective,
randomized, pragmatic trial. Reg Anesth Pain Med 2022; 47(12):
-748. https://doi.org/10.1136/rapm-2022-103680.
Çevikkalp E, Baytar Ç. Comparison of postoperative analgesic
effectiveness of caudal block, dorsal penile nerve block, and
pudendal nerve block in children undergoing circumcision.
Cukurova Med J 2022; 47(1): 169-174.
https://doi.org/10.17826/cumj.1020556.
Boretsky KR. Pediatric Regional Anesthesia Advances. Curr
Anesthesiol Rep 2019; 9(2): 100-109.
Downloads
Published
How to Cite
Issue
Section
