Role of pudendal nerve block for prevention of catheter-related bladder discomfort in male pediatric patients undergoing hypospadias surgery: a prospective randomized control study

Abstract

Abstract Background Catheter-related bladder discomfort (CRBD) is a common distressing symptom complex during the postoperative period, especially after urologic procedures followed by urinary catheterization. The purpose of this study is to evaluate the efficacy of pudendal nerve block and compare it with intravenous butylscopolamine in CRBD prevention in pediatric male patients undergoing hypospadias surgery under general anesthesia. Results After getting ethical committee clearance and informed written consent, 60 male pediatric patients scheduled for hypospadias repair were enrolled for the study and were randomized using computer-generated random numbers in 2 groups of 30 each: group P (received bilateral pudendal nerve block using 0.25% ropivacaine) and group B (received intravenous butylscopolamine 0.3 mg/kg) 15 min before extubation. The primary outcome was the incidence and severity of CRBD. Visual analog scale (VAS) for postoperative pain, postoperative side effects, the postoperative requirement for tramadol as a rescue treatment for CRBD and fentanyl as rescue analgesia for postoperative pain, and VAS for acceptance of an indwelling urinary catheter were the secondary outcomes. The incidences of CRBD and side effects were analyzed by the chi-square test and severity by Fisher’s exact test. The VAS scale was analyzed by the Mann-Whitney test. A p value of < 0.05 was considered significant. Group P had significantly decreased incidence as well as severity of postoperative CRBD than group B with p < 0.05. The postoperative median VAS score and number of patients requiring fentanyl as rescue analgesics were significantly low in group P in comparison with group B (p < 0.05). The total tramadol requirement at the end of 6 h for CRBD management was also significantly reduced in group P (p < 0.0001). Conclusions Pudendal nerve block seems to be superior to intravenous butylscopolamine in reducing the incidence and severity of CRBD. This study can be extrapolated to other urogenital studies in pediatric patients.

Keywords

• Anti-muscarinics
• Butylscopolamine
• CRBD
• Hypospadias repair
• Pediatric patients
• Pudendal nerve block