Clinical trial NCT06500286: Dorsal Nerve Block and Caudal Block in Hypospedius Repair in Children
Official title: Comparison Between Dorsal Nerve Block and Caudal Block Effect in Post Operative Pain in Hypospedius Repair in Children
Study type: INTERVENTIONAL
Overall status: NOT_YET_RECRUITING
Phase: PHASE1
Conditions: Dorsal Nerve Block in Hypospiudus
Lead sponsor: Assiut University
Sponsor class: OTHER
First posted: 2024-07-15
Enrollment: 103
Sex: MALE
Minimum age (years): 2
Maximum age (years): 12
Standard ages: CHILD
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: Comparison between Dorsal nerve block and caudal block effect in post operative pain in hypospedius repair in children Randomoized clinical trial

Detailed description: • Group A receive caudal block placing the patient into the left lateral decubitus position. Povidone iodine was used to sterilize the skin. The sacral hiatus was found by palpating the sacral cornu and a 22-G needle was placed through it. After passing through the sacrococcygeal membrane by using the loss of resistance method, the caudal epidural space was entered. Negative aspiration was used to make sure there was no blood or cerebrospinal fluid present and 0.25% bupivacaine was administered at a dose of 0.2 ml/kg. Once the procedure was completed, the patient was placed into the supine Position.

Group B US guided Dorsal penil block. General anesthesia induction was followed by skin sterilization using 70% alcohol in 2% chlorhexidine. The 5-10 MHz linear probe was placed at the penis root, making it possible to observe the corpus cavernosum, corpus spongiosum, dorsal artery and vein, and the deep penile fascia (Buck's fascia) on the transverse plane with gentle penile traction. The in-plane technique was then used to insert a 50-mm block needle toward the dorsal penile section from the lateral part of the penis root. The needle was then advanced from the hyperechoic superficial penis fascia (Dartos fascia) and the superficial sheath was passed. After advancing the needle into Buck's fascia, the needle was placed lateral to the dorsal artery, at a position between Buck's fascia and tunica albuginea. Negative aspiration was performed. US was then used to observe the distribution of the anesthetic while half of the total 0.25% bupivacaine dose (0.2 mL/kg) was administered (Fig. 1). Afterward, the same procedure was also performed on the other side of the penis.

Eligibility criteria: Inclusion Criteria:

* aged 2-12 years
* ASA physical status I or II

Exclusion Criteria:

* asthmatic patients
* emergency surgery
* intellectual disability
* neurological diseases with agitation-like symptoms
* renal or hepatic disease,
* cardiac or respiratory disease
* allergy to the study drugs
* parent refusal
* psychiatric diseases

Primary outcomes:
measure: Efficacy of dorsal penile block
timeFrame: 1year
Secondary outcomes:
measure: Comparison between post operative analegesia effect and side effect of dorsal penileblock and caudal block
timeFrame: 1year
Other outcomes:
Locations:
Study officials:
affiliation: Resident
name: Soha Abdelhamid Fawzy, Resident
role: PRINCIPAL_INVESTIGATOR
References:
citation: Baskin LS, Lee YT, Cunha GR. Neuroanatomical ontogeny of the human fetal penis. Br J Urol. 1997 Apr;79(4):628-40. doi: 10.1046/j.1464-410x.1997.00119.x.
citation: Ngoo A, Borzi P, McBride CA, Patel B. Penile nerve block predicts higher revision surgery rate following distal hypospadias repair when compared with caudal epidural block: A consecutive cohort study. J Pediatr Urol. 2020 Aug;16(4):439.e1-439.e6. doi: 10.1016/j.jpurol.2020.05.150. Epub 2020 Jun 6.
citation: Hueber PA, Salgado Diaz M, Chaussy Y, Franc-Guimond J, Barrieras D, Houle AM. Long-term functional outcomes after penoscrotal hypospadias repair: A retrospective comparative study of proximal TIP, Onlay, and Duckett. J Pediatr Urol. 2016 Aug;12(4):198.e1-6. doi: 10.1016/j.jpurol.2016.04.034. Epub 2016 Jun 2.
citation: Spinoit AF, Poelaert F, Van Praet C, Groen LA, Van Laecke E, Hoebeke P. Grade of hypospadias is the only factor predicting for re-intervention after primary hypospadias repair: a multivariate analysis from a cohort of 474 patients. J Pediatr Urol. 2015 Apr;11(2):70.e1-6. doi: 10.1016/j.jpurol.2014.11.014. Epub 2015 Feb 26.