• Anesthesia and analgesia · Dec 2013

    Randomized Controlled Trial Comparative Study

    The effectiveness of pudendal nerve block versus caudal block anesthesia for hypospadias in children.

    Pudendal nerve block provides better analgesia in the first 24 hours for children following hypospadias repair than does caudal block.

    pearl
    • Zoher M Naja, Fouad M Ziade, Raymond Kamel, Sabah El-Kayali, Nabil Daoud, and Mariam A El-Rajab.
    • From the *Anesthesia and Pain Management Department, Makassed General Hospital; †Health and Environmental Science Department, Faculty of Public Health, Lebanese University; ‡Chief of Division of General Pediatrics, Pediatrics Department, Saint George Hospital University Medical Center, Beirut, Lebanon; and §Anesthesia Department, Mowasat University Hospital, Damascus, Syria; and ‖Pediatrics Department, Makassed General Hospital, Beirut, Lebanon.
    • Anesth. Analg.. 2013 Dec 1;117(6):1401-7.

    BackgroundCaudal block (CB) has some disadvantages, one of which is its short duration of action after a single injection. For hypospadias repair, pudendal nerve block (PNB) might be a suitable alternative since it has been successfully used for analgesia for circumcision. We evaluated PNB compared with CB as measured by total analgesic consumption 24 hours postoperatively.MethodsIn this prospective, double-blinded study, patients were randomized into 2 groups, either receiving CB or nerve stimulator-guided PNB. In the PNB group, patients were injected with 0.3 mL/kg 0.25% bupivacaine and 1 µg/kg clonidine. In the CB group, patients were injected with 1 mL/kg 0.25% bupivacaine and 1 µg/kg clonidine. Analgesic consumption was assessed during the first 24 hours postoperatively. The "objective pain scale" developed by Hannalah and Broadman was used to assess postoperative pain.ResultsEighty patients participated in the study, 40 in each group. The mean age in the PNB group was 3.1 (1.1) years and in the CB group was 3.2 (1.1) years. The mean weights in the PNB and CB groups were 15.3 (2.8) kg and 15.3 (2.2) kg, respectively. The percentage of patients who received analgesics during the first 24 hours were significantly higher in the CB (70%) compared with the PNB group (20%, P < 0.0001). The average amount of analgesics consumed per patient within 24 hours postoperatively was higher in the CB group (paracetamol P < 0.0001, Tramal P =0.003).ConclusionPatients who received PNB had reduced analgesic consumption and pain within the first 24 hours postoperatively compared with CB.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

    comment
    1

    Interesting to note that not only did the pudendal nerve block group experience better analgesia than the caudal block group, they were also exposed to a much smaller absolute dose of bupivacaine (0.75 mg/kg vs 2.5 mg/kg). This is important not only because of the safety implications, but also because allows extra LA for top-up if the block is inadequate or fails.

    Daniel Jolley  Daniel Jolley
    pearl
    1

    Pudendal nerve block provides better analgesia in the first 24 hours for children following hypospadias repair than does caudal block.

    Daniel Jolley  Daniel Jolley
     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…