title: Surgical outcome in children undergoing hypospadias repair under caudal epidural vs penile block.
abstract: OBJECTIVE
  To evaluate the effect of penile block vs caudal epidural on the quality of analgesia and surgical outcome following hypospadias repair.
  
  
  BACKGROUND
  Intraoperative penile engorgement because of caudal epidural may result in tension on surgical sutures and alter surgical outcome.
  
  
  METHODS
  Fifty-four ASA I and II children were randomly allocated to group P (penile block, 0.25% bupivacaine, 0.5 mg·kg(-1) ; n = 27) and group C (caudal epidural, 0.25% bupivacaine, 0.5 ml·kg(-1) ; n = 27), respectively. Quality of analgesia was assessed by visual analog scale (VAS) score recorded at 0, 0.5, 3, 6, 12, 24 h, and once a day for the next 4 days. Duration of analgesia was calculated from the institution of block to the first analgesic demand by child or VAS > 5. Total morphine consumption in the first 48 h and oral paracetamol consumption till 5th day were recorded. Children were regularly followed up in their respective outpatient clinic for early or late complications.
  
  
  RESULTS
  In group P, lower mean VAS scores were seen from 0.5 h after surgery till day 3 and analgesia lasted for significantly longer duration (82 min) when compared with caudal epidural, P < 0.001. Incidence of urethral fistula formation after primary hypospadias repair was 19.2%, and all had received caudal epidural. An increase of 27% in penile volume from baseline value was observed 10 min after caudal epidural placement, P < 0.05.
  
  
  CONCLUSIONS
  Penile block provided better analgesia when compared with caudal epidural in children undergoing primary hypospadias repair. Postoperative urethral fistula formation was more likely in children who received caudal epidural.
authors.affiliation: Department of Anaesthesiology & Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India. p_kundra@hotmail.com
authors.forename: Pankaj
authors.initials: P
authors.lastname: Kundra
authors.forename: Kotteeswaran
authors.initials: K
authors.lastname: Yuvaraj
authors.forename: Karoon
authors.initials: K
authors.lastname: Agrawal
authors.forename: Sudeep
authors.initials: S
authors.lastname: Krishnappa
authors.forename: Lalla T
authors.initials: LT
authors.lastname: Kumar
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000767:Anesthesia, Epidural; D001794:Blood Pressure / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D008297:Male; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D009407:Nerve Block; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy; D010410:Penile Erection / Q000187:drug effects; D010413:Penis / Q000033:anatomy & histology / Q000502:physiology* / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D011229:Preanesthetic Medication; D016896:Treatment Outcome; D014548:Urinary Fistula / Q000453:epidemiology / Q000209:etiology
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000082:Acetaminophen; D009020:Morphine