PENILE BLOCK TIMING FOR POSTOPERATIVE ANALGESIA OF HYPOSPADIAS REPAIRIN CHILDREN

Purpose: It has been well established that a dorsal penile nerve block immediately after surgery decreases postoperative pain in children un dergoing hypospadias repair. However, to our knowledge the efficacy of a penile block immediately before versus immediately after surgery fo r postoperative pain control has not been previously studied in such c hildren. Materials and Methods: We evaluated 98 healthy boys 6 months to 12 years old undergoing hypospadias repair. General anesthesia was induced and maintained in a standard fashion. Patients were randomly a ssigned to receive a penile block with the same total dose of bupivaca ine at the completion of surgery, before the incision or before and at the completion of surgery. No other analgesic was administered intrao peratively. Pain was assessed using a modified objective pain-discomfo rt scale at 15 minutes, and 3, 12 and 24 hours after surgery. The numb er of doses of acetaminophen required to control postoperative pain wa s also recorded, Results: Pain scores were defined in a range of 0 - n o pain to 6 - greatest pain. During recovery median pain scores in the 30, 36 and 32 boys who received a penile block after, before, and bef ore and after surgery were 3, 1.5 and 0 at 15 minutes; 2.5, 1 and 0 at 3 hours; 3, 2 and 0 at 12 hours; and 1, 0 and 0 at 24 hours, respecti vely. There was no difference in acetaminophen doses required 15 minut es and 3 hours postoperatively in the 3 groups. By 12 hours after surg ery the number of acetaminophen doses required for pain control was si gnificantly lower in the before and after, and before groups than in t he after group. By 24 hours boys in the before and after group require d significantly fewer doses of analgesics than those in the after and before groups. There was no statistically significant difference betwe en the after and before groups. Conclusions: Two penile blocks perform ed at the beginning and conclusion of hypospadias repair, respectively , provide better postoperative pain control than 1 penile black done b efore or after surgery (p <0.05). These patients require less analgesi c than those who receive a penile block only before or only after surg ery.