Abstract

Introduction: In hypospadias surgery, pain control is ordinarily provided by analgesic suppository drugs and paranteral analgesics which are applied in the postoperative period. However, with these methods it is not always possible to provide pain control on sufficient level and time. Especially, complications (bleeding, infection, catheter extraction) and agitation observed during waking up after anesthesia can negatively affect the success of the operation.

In our study; we compared the results of patients in whom caudal block procedure was applied and not applied.

Materials and Methods: A total of 59 children, who underwent TIPU operation due to midpenile hypospadias under general anesthesia, were included in our study. The patients were seperated into two groups. In group 1 (n: 29), we applied bupivacaine in a dose of 1.25 mg/kg for achieving preoperative caudal block. In group 2 (n: 30), caudal block was not applied. For postoperative analgesia, paracetamol (in a dose of 10 mg/kgx3 suppository form) was used. In the evaluation of postoperative pain, we used Face Pain Scale at 0-8 and 8-24 hours. The scale was scored from 0 to 5. We evaluated mean arterial pressures, changes in respiration rates, changes in heart rates and the need for additive analgesic usage in both groups. We also evaluated postoperative early term complications in patients with caudal block. Repeatative Pillia’s Trace Test was used for statistical evaluation.

Results: There were no statistical differences between the groups by means of changes in respiration rates, heart rates and mean arterial pressures. Due to failure of pain control in patient group without caudal block, some complications were detected in 6 patients (bleeding in 4 patients, catheter extraction in 1 patient and wound dehiscence in 1 patient). Bleeding was detected in 1 patient in the group with caudal block. We have found statistical difference between groups by means of complications (p<0.0001). According to the grading of face pain scale; the pain level of patients, in the caudal block group, progressed under 1 without a change between 0-8 and 8-24 hours. In patients who were not applied caudal block procedure it was 4 when the patient wake up and analgesic affect it decreased. There was statistical difference in pain score according to Face Pain Scale between 2 groups (p<0.0001). Additional analgesics (in a dose of 10 mg/kg paracetamol suppository form) were needed for only one patient in whom the caudal block procedure was applied. On the other hand additional analgesics (in a dose of 0,05 mg/kg morphine HCL parenteral form) was needed for 9 patients in whom the caudal block procedure was not applied. There was a statistical difference between two groups, according to the statistical evaluation of analgesic usage (p<0.0001).

Conclusion: Hypospadias surgery in children with caudal block is an easy and safe procedure. In our study, we demonstrated that postoperative early complications were reduced by effective pain control with caudal block.