Analgesic efficacy of ultrasound-guided pudendal nerve block versus caudal block for penile surgeries in children

Abstract Background and Aims: Pain management strategies in pediatric penile surgery are an essential component of anesthetic care that directly influences maternal-child comfort in the postoperative period. While caudal analgesia remains the standard technique, ultrasound-guided regional techniques, particularly the pudendal nerve block, have emerged as viable alternatives. This study explores the analgesic efficacy of ultrasound-guided pudendal block versus caudal blockade using clonidine as an adjuvant in children undergoing penile surgeries. Material and Methods: This prospective, randomized, comparative study included 60 children aged 6 months to 6 years scheduled for penile surgery. Children were randomly assigned to either Group A (Caudal Block) or Group B (Ultrasound-Guided Pudendal Nerve Block) and received 0.2% ropivacaine with clonidine (1 mcg kg -1 ) as an adjuvant. A blinded observer assessed the FLACC scale, the number of rescue analgesia doses within 24 hours, and the duration of analgesia. The primary outcome was the difference in rescue analgesia requirements. Results: There was no significant difference in rescue analgesia requirements between the groups (P 0.92). Eleven patients (36.7%) in both the groups did not require any rescue analgesia within 24 hours postextubation. The median time to first rescue analgesia was 11.5 hours (6–24) in Group A and 12.3 hours (6.5–24) in Group B (P- 0.72). The FLACC scores were comparable between groups. Conclusions: The pudendal nerve block provides analgesia comparable to caudal block in terms of rescue analgesia requirements and duration of analgesia when clonidine is added with local anesthetics.