Pain management with ultrasound-guided lidocaine-ropivacaine caudal block in hypospadias repair: A single-surgeon comparative study

Abstract

Background: Postoperative pain management in hypospadias surgery can be challenging, especially with the occurrence of postoperative penile erection, which is usually accompanied with bleeding and often interferes with wound healing. Ultrasound-guided caudal epidural block is easy to administer and can attenuate postoperative physiological stress response. In this study, we compared the effect of pain control among patients receiving standard general anesthesia (Group G) and among those receiving caudal analgesics of lidocaine-ropivacaine (Group GC). Methods: A total of 100 patients needing hypospadias repair for the first time were consecutively enrolled; 50 patients received caudal analgesics depending on available anesthesiologists. All patients were operated on by the same experienced surgeon. Primary outcome included pain and sedation scores, and the incidence of painful erections within 24 hours following surgery. Heart rate (HR) and analgesic requirement were also compared. Results: Baseline characteristics and vital statistics did not differ between the two groups. Postoperative erections were significantly less frequent in the GC than in the G group (22% vs. 64%, P < 0.05). The HRs and pain scores of the GC group were lower than those of the G group (P < 0.05) in the first 12 hours. Postoperative sedative effect was better and analgesic requirement less for the GC than the G group (P < 0.05) in the first 24 hours. Conclusion : Caudal lidocaine + ropivacaine can provide effective pain management in the early postoperative period and reduce the occurrence of painful erections. Further volume dosing studies are needed to refine the strategy for optimal pain control.