title: The effectiveness of pudendal nerve block versus caudal block anesthesia for hypospadias in children.
abstract: BACKGROUND
  Caudal 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.
  
  
  METHODS
  In 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.
  
  
  RESULTS
  Eighty 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).
  
  
  CONCLUSIONS
  Patients who received PNB had reduced analgesic consumption and pain within the first 24 hours postoperatively compared with CB.
authors.affiliation: 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.
authors.forename: Zoher M
authors.initials: ZM
authors.lastname: Naja
authors.forename: Fouad M
authors.initials: FM
authors.lastname: Ziade
authors.forename: Raymond
authors.initials: R
authors.lastname: Kamel
authors.forename: Sabah
authors.initials: S
authors.lastname: El-Kayali
authors.forename: Nabil
authors.initials: N
authors.lastname: Daoud
authors.forename: Mariam A
authors.initials: MA
authors.lastname: El-Rajab
mesh_terms: D000367:Age Factors; D000700:Analgesics / Q000627:therapeutic use; D000758:Anesthesia; D016009:Chi-Square Distribution; D002675:Child, Preschool; D004311:Double-Blind Method; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D007223:Infant; D007861:Lebanon; D008297:Male; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D060525:Pudendal Nerve; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000700:Analgesics