Caudal Block Provides Benefit with Shorter Perioperative Recovery Times as well Decreased Perioperative Morphine Use in Hypospadias Repair
Cynthia A. Sharadin, MD, Jacob P. Williamson, BS, Deborah L. Jacobson, MD, MS, Glen A. Lau, MD, Anthony J. Schaeffer, MD, MPH, Patrick C. Cartwright, MD, M. Chad Wallis, MD.
University of Utah, Salt Lake City, UT, USA.
Background: There is controversy regarding the pain control afforded by caudal versus penile block in the population undergoing hypospadias repair. This study aims to determine if there are differences in perioperative pain control between the two blocks. We hypothesized that caudal blocks would provide superior perioperative analgesia when compared to penile blocks among boys undergoing hypospadias repair. Methods: We retrospectively reviewed the 224 boys enrolled in our prospectively collected hypospadias outcomes database from 11/2017 - 2/2023. We abstracted procedure information, perioperative and recovery times, type of pain block received, and analgesic use in morphine equivalents. We excluded boys who received more than one type of block, those who did not undergo a block, and those who underwent concomitant surgeries. Mann-Whitney U and Chi-Squared testing was performed. Results: There were 179 boys repaired at a median age 8.3 months eligible for the study; 60 underwent a caudal block (caudal group) and 119 underwent a penile block (penile group). Median urethroplasty length in both groups was 8 millimeters. Operative time was not significantly different between the groups (109 minutes in the caudal group versus 99 minutes in the penile group, p=0.13). Median total anesthesia time was longer in the caudal group (152 minutes) than the penile group (135 minutes, p=0.008). Median morphine equivalents used during the anesthetic were lower in the caudal group (2.5 mg/kg) than the penile group (4.8mg/kg, p=0.006). While PACU pain scores were similar between the groups, the median PACU time was significantly lower in the caudal versus penile group (31 minutes versus 37 minutes, p=0.025). The median total morphine equivalents used were lower in the caudal group (3.1mg/kg) than the penile group (5.3 mg/kg, p=0.001). Conclusions: While operative times were similar between groups, anesthesia times were longer in the caudal group. However, PACU recovery time, intraoperative narcotic use, and postoperative narcotic use were significantly lower among patients undergoing a caudal block. This study informs an upcoming prospective, double-blinded, randomized, controlled trial of caudal versus penile blocks for hypospadias repair.
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