pudendal vs caudal block for pediatric penile surgery

Conditions: Postoperative Pain

Summary: the study will compare recovery profile in children receiving pudendal blocks vs caudal analgesia for ambulatory circumcision or hypospadias repair in children between 6 months and 2 years. the subjects of the study will be randomized to receive either a caudal or a pudendal block.

the study participation will begin on the day of surgery and end at the time of last surgical follow-up visit, approximately two weeks later. all procedure related, follow-up clinic visit and pacu data will be collected by the research team from the patient's epic record (demographic data, pain scores in the pacu, analgesic consumption, time to perform block, time to discharge, etc). data pertaining to the recovery of patient at home will be collected via phone call or email to the caregiver of the child. late complications will be identified by reviewing the follow-up surgical note. questionnaire administration the physical pain journal/questionnaires the physical pain journal/questionnaires will be handed out to the caregiver before discharge from the post-anesthesia care unit. the caregiver will fill out pain scores at home in the pain journal. the pain scores used (flacc and pppm) have been extensively validated. in addition, written instructions for using the pain scores to guide pain management interventions at home will be provided. prior to discharge, caregivers will also be educated by a member of the research team on pain evaluation using the pain score and pain management algorithm. the caregiver will be asked to answer a short questionnaire (postoperative parent survey) about their child pain in the first 24 hours after discharge from the hospital. the caregiver will receive a phone call from the research team 24-48 hours after discharge to retrieve the results of the pain journal and postoperative pain survey. phone calls approximately 24-48 hours after the child is discharged from the hospital, a member of the study team will call the caregivers/parents to retrieve the journal responses and check on the health status of the child. during this call, if there are any adverse event that may be related to the block that was performed noted, this will be documented on the ae log and a follow-up phone call will be made approximately 7 days after to verify if the event has ended or is ongoing. upon learning about any potential related ae, the investigator will determine its severity and relationship to the study procedure and report the event per university of chicago guidelines.

Eligibility criteria:
inclusion criteria: * - children aged 6 months -3 years * scheduled for elective outpatient circumcision or hypospadias repair exclusion criteria: * asa classification ≥ 3 * emergency surgery * history of a complex regional pain syndrome * sacral dimple * known vertebral spinal abnormalities, spinal dysraphism * history of long-term analgesic use * use of any analgesic (e.g., an opioid medication, acetaminophen, or a nonsteroidal anti-inflammatory agent) within 24 hours before surgery * history of renal insufficiency or a bleeding disorder * concurrent additional surgery at another anatomic site * being a ward of the state * a non-english speaking patient or primary caregiver * inability of the primary caregiver to comply with home instructions

Keywords: nerve block caudal block pudendal block circumcision hypospadias postoperative analgesia opioid consumption pain score