Analgesic efficacy and impact of pudendal block on surgery in children: a systematic review and meta-analysis

Abstract

Abstract Background Both hypospadias and circumcision are common genital surgeries in pediatric patients who that can cause serious postoperative pain and have long-term effects.Pudendal block (PNB) has recently been studied in children undergoing both hypospadias surgery and circumcision. Objective We sought to perform a meta-analysis to estimate the analgesic efficacy, relative complications and satisfaction of pudendal block for hypospadias repair and circumcision in children. Evidence Review We identified comparative studies of pudendal block versus dorsal penile nerve block (DPNB) or caudal blocks (CB); studies were published or presented through 31 December 2021. Data were abstracted from studies comparing pudendal block versus dorsal penile nerve block (DPNB) or caudal blocks (CB). Original source data were used when available. Data from 298 patients in four RCTs were included. Findings Compared with traditional nerve blocks, the pudendal nerve block group showed no detectable difference in terms of patients who needed additional analgesia within 24 hours after the surgery (OR 0.12; p=0.09)or at 30 min(OR 0.10; p=0.13). However, it showed that fewer people needed additional analgesia at 18 h (OR 0.02; p＜0.0001) and at 12 h (OR 0.02; p=0.0001). Limited data showed that fewer people needed additional analgesia at 6 h (OR 0.03; p<0.00001), 1 h (OR 0.11; p=0.04), and 5 min (OR 0.05; p=0.0004). Compared with traditional nerve blocks, the pudendal nerve block group showed no detectable difference in terms of postoperative complications (OR 0.19; p=0.13). Compared with traditional nerve blocks, the pudendal nerve block group had better surgical satisfaction (OR 8.71; p=0.0001) and parent satisfaction (OR 12.52; p＜0.00001). Conclusions Compared with traditional blocking methods (CB and DNPB), for pediatric penile surgery, it hasshown that pudendal nerve block has better early postoperative analgesia and better surgical satisfaction and parental satisfaction with no obvious postoperative complications.