Comparison of postoperative analgesic efficacy of dorsal penile nerve block(DPNB) and caudal block in patients undergoing hypospadias surgery
1Dr Zohaib Hidayat, 2Dr Obaidullah, 3Dr Fazal e Amin Ghani ur Rehman, 4Dr Fahad Dayam, 5Dr Abdul Aziz, 6Dr Asad Asghar
1Assistant Professor of Plastic Surgery, Mercy Teaching Hospital, Peshawar
2Professor of Plastic Surgery, Northwest General Hospital and Research Center Peshawar.
3House Officer Mercy Teaching Hospital Peshawar
4House officer Kuwait Teaching Hospital, Peshawar
5House officer Kuwait Teaching Hospital, Peshawar
6House officer Kuwait Teaching Hospital, Peshawar
Vol: 16/03, 421-429
Received: May 01, 2025 Accepted: July 22, 2025 Published: September 26, 2025.
Abstract Background: Caudal block is the preferred method of anaesthesia for the surgical procedures of lower part of the body, mainly below the umbilicus. The role of dorsal penile nerve block at the start of surgery decreases post-operative pain in children undergoing hypospadias repair. We aim to compare the efficacy of caudal block versus dorsal penile block (DPNB) under general anaesthesia for patients undergoing hypospadias repair. Methods: This study was performed between January 1, 2020 and October 16, 2020 at Plastic, Burn and Reconstructive Surgery Department of Northwest General Hospital and research Centre, Peshawar. Fifty-two male patients, American Society of Anaesthesiologists physical status classification I, aged between 3 and 18 years were included in this randomized, prospective, comparative study. Anaesthetic techniques were standardized for all patients. Patients were randomized into 2 groups. Using 0.5% Bupivacaine with adrenaline 1:100,000, we performed DPNB for Group 1 and same anaesthetist performed caudal block with 0.25% Bupivacaine for Group 2. Postoperative analgesia was evaluated hourly for fifteen hours with the Wong-Baker FACES pain rating scale and findings recorded in a proforma. For every patient, total surgery time supplemental analgesic amounts, times, and probable local or systemic complications were recorded. Results: All patients remained stable during anaesthesia. Post operatively mean pain score showed a statistically significant difference between the groups. Lower pain scores were recorded in DPNB group during the first 15 hours, in the recovery room as well as the postoperative ward. The mean duration of analgesia was significantly prolonged (mean of 10 hours in DPNB vs 6 hours in caudal block) and the requirement for rescue analgesics were significantly less in the DPNB group (p < 0.0001) postoperatively. No major complication was found when using either technique. Conclusions: It seems that in patients undergoing hypospadias surgery, DPNB provided a much longer postoperative analgesia as compared to caudal block, with additional benefit of decreased overall surgery time. Keywords: analgesic, caudal block, hypospadias, dorsal penile nerve block(DPNB), bupivacaine