Ultrasound‐guided dorsal penile nerve block vs neurostimulator‐guided pudendal nerve block in children undergoing hypospadias surgery: A prospective, randomized, double‐blinded trial

Abstract

Background and Aims Hypospadias is a common congenital malformation in pediatric patients. Surgical repair of this malformation is a painful procedure and has long‐term effects. Pudendal and penile nerve blocks are commonly preferred techniques for maintaining postoperative analgesia. However, the conventional landmark‐based penile block technique involves numerous potential complications and provides a shorter analgesic period compared to the pudendal block. A promising ultrasound‐guided dorsal penile nerve block was recently described. We aimed to compare the analgesic effectiveness of ultrasound‐guided penile nerve block with that of neurostimulator‐guided pudendal nerve block. Method Thirty‐three patients aged 1‐7 years were included in this prospective, double‐blinded, randomized controlled trial. Patients were divided into two groups and received either ultrasound‐guided dorsal penile nerve block or neurostimulator‐guided pudendal nerve block. All blocks were performed by the same two anesthesiologists, and the same surgeons performed the surgical procedures. The Face, Legs, Activity, Cry, and Consolability (FLACC) scale was used for postoperative pain management. The primary outcome of the study was time to first analgesic requirement. Secondary outcomes were FLACC scores at different time points, and types and cumulative doses of analgesic drugs. Results Dorsal penile nerve block provided longer analgesia than pudendal nerve block (32.29 ± 5.47 hours and 21.13 ± 3.53 hours, respectively; differences in mean: 11.16, 95% CI: 7.873‐14.465) (P < .001). FLACC scores at the time of first analgesic requirement were significantly lower in dorsal penile nerve block group than pudendal nerve block group (median [IQR]: 2 [2‐2.5] and 3 [3‐5], respectively; differences in median: −1, 95% CI: −1.851 to −0.149) (P < .001). Conclusion Ultrasound‐guided dorsal penile nerve block provided a longer analgesic period and reduced opioid consumption compared to neurostimulator‐guided pudendal nerve block.

A Comparison of the Postoperative Analgesic Effectiveness of Ultrasound-Guided Dorsal Penile Nerve Block and Ultrasound-Guided Pudendal Nerve Block in Circumcision

“…Kendigelen et al [22] similarly compared a pudendal nerve block with a caudal block and reported significantly higher parental satisfaction scores in the pudendal group. Aksu et al [15] also reported a high degree of satisfaction in the DPNB group in their study comparing DPNB with a pudendal nerve block. The high degree of parental satisfaction in our study could be due to the low pain scores in both groups, the comfortable postoperative period of the patients, and the lack of complications related to block administration.…”

“…Naja et al [13] found block failure in 7% of patients receiving DPNB with the landmark and none of the patients receiving a pudendal nerve block with a neurostimulator. The reason of the block failure with the landmark technique or when aided by a neurostimulator could be failure of the administered LA to reach the nerve adequately as both are blind techniques [13][14][15]. DPNB has anatomical limitations, and US guidance is necessary to use the technique.…”

A randomised‐controlled, prospective study on the effect of dorsal penile nerve block after TURP on catheter‐related bladder discomfort and pain

“…[21][22][23][24][25] It is recommended to be administered with USG guide. 21,23,32 The advantages of using USG are to visualise the scarpa fascia, to enable the distribution of local anaesthetic, and to help prevent intravascular injection. Moreover, through real-time evaluation, it helps to prevent organ damages such as the corpora cavernosa or the urethra injury.…”

“…Penile nerve block (PNB) is a type of block that is frequently used in circumcision and hypospadias surgery, especially in children. It reduces postoperative pain and the need for analgesics 21‐23 . In adults, penile prosthesis and penile surgeries have been used to reduce pain and the amount of analgesic.…”

Efficacy and safety of pudendal nerve block for postoperative analgesia of hemorrhoids: a systematic review of 7 randomized controlled trials

“…With the development of new technologies, more and more instruments have emerged, such as ultrasound, neurostimulator, CT, etc. (25)(26)(27). These instruments can be selected based on individualized conditions to locate the nerve and improve the safety of the operation.…”