# 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

## TL;DR

This study found that a dorsal penile block provides better pain relief than a caudal epidural block for children after hypospadias surgery.

## Contribution

The study compares two ultrasound-guided anesthetic techniques for postoperative pain in children undergoing hypospadias repair.

## Key findings

- Dorsal penile block delayed the need for additional pain medication significantly longer than caudal epidural block.
- Children receiving dorsal penile block had lower postoperative pain scores compared to those receiving caudal epidural block.
- Dorsal penile block required less rescue analgesia within 24 hours than caudal epidural block.

## Abstract

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.