COMPARISION OF ULTRASOUND GUIDED PUDENDAL NERVE BLOCK AND CAUDAL EPIDURAL BLOCK FOR POST OPERATIVE ANALGESIA IN CHILDREN UNDERGOING HYPOSPADIAS REPAIR.

Regional anaesthetic techniques are frequently used with general anaesthesia to manage intra and post-operative pain, reduce parenteral opioid requirement, and facilitate pain control during paediatric procedures. One of the most often used regional anaesthesia techniques in children is caudal epidural block (CEB). However, single injection CEB has a short duration of action and anatomical variations, and abnormalities may make administration of CEB challenging. Recently, peripheral nerve blocks are increasingly being employed for peri-operative analgesia when appropriate, as they have less risk of side effects as combined with neuraxial procedures. Also, the availability of ultrasound machines has made this easier and safer. Pudendal nerve block (PNB) is a peripheral nerve block that is frequently used to provide efficient pain control after penile surgery. A few previous studies have shown that PNB is effective for providing prolonged post operative analgesia.1,2 PNB can be accomplished utilising a landmark technique with transcutaneous use of a peripheral nerve stimulator or by ultrasonographic guidance (USG).2 Naja ZM et al compared effectiveness of PNB with CEB and found that the percentage of patients who received analgesics during the first 24 hours after hypospadias surgery was significantly higher in the CEB (70%) compared with the nerve stimulator guided PNB group (20%, p < 0.0001) and analgesic consumption was also higher in the CEB group.1 We decided to compare USG guided PNB with CEB for post operative analgesia in children undergoing hypospadias surgery.