مقارنة بين حصار القضيب و الحصار الذيلي في جراحة الإحليل التحتي عند الأطفال

الملخص EN

Background& Objective: intraoperative penile engorgement because of caudal epidural block may result in tension on surgical sutures and alter surgical outcome Aim & objective: to compare between the effect of penile block &caudal epidural block on the quality of analgesia & surgical outcome following hypospadias repair Materials & Methods: a prospective study on 100ASA I – ll children aged 3 to 10 years, in the children university hospital, anesthesia & reanimation department 2007, 2010.

They were randomly allocated to group P( penile block with Bupivacaine 0.5% ; 0.1 ml⁄ kg n : 50 patients , and 40 children aged < 6 years divided equally between the two groups ), max dose 5 ml for each side.

And group C ( caudale epidural block with Bupivacain 0,5% .

05ml⁄ kg n: 50 patients ) respectively.

This study was done with several surgeons .quality of analgesia was evaluated by visual analog scale VAS score recorded at 1, 3,6,12,24 h.and once a day for the next 3 days in children aged more than 6 years , while for the youngers we monitored the cardiovascular stability under general anesthesia (defined as an increase in heart rate and blood pressure by up to 20% from baseline upon starting).

Duration of analgesia was calculated from the institution of block to the first analgesic demand by child.

Total consumption of paracetamol iv and acetaminophen in the first 48 h and oral paracetamol consumption till 4th day were recorded .children were regularly followed up by the interns in outpatient clinic for early or late complications.

Results: in group P, lower mean VAS scores were seen from 1 h after surgery till day 3 and the duration of analgesia was longer when compared with caudal epidural.

Incidence of urethral fistula formation after primary hypospadias repair was 8%in group C only ,an increase in penile volume was observed by surgeons 10 min after caudal epidural block .( surgeons from multiple schools ) .

Conclusion: penile block provided better analgesia and less bleeding when compared with caudal epidural block in children undergoing primary hypospadias repair.

Postoperative urethral fistula formation was more likely in children who received caudal epidural