Comparison of Sacral ESP Block and Dorsal Penile Nerve Block in Pediatric Hypospadias Surgery

Hypospadias surgery in pediatric patients can cause significant postoperative pain. While Dorsal Penile Nerve Block (DPNB) is a standard regional technique, the Sacral Erector Spinae Plane (ESP) block has emerged as a potential alternative for trunk and pelvic analgesia.

In this prospective, randomized, double-blind study, 70 pediatric patients (ASA I-II, aged 1-7 years) will be randomly assigned to receive either a Sacral ESP block or a DPNB under general anesthesia. Both blocks will be performed under ultrasound guidance using 0.25% bupivacaine, administered at a volume of 0.4 mL/kg for the Sacral ESP block and 0.4 mL/kg for the DPNB.

Postoperative pain will be assessed using the FLACC (Face, Legs, Activity, Cry, Consolability) scale at 30 minutes, 1, 2, 6, 12, and 24 hours. The study aims to determine if Sacral ESP provides superior or non-inferior analgesia compared to DPNB, specifically focusing on the 12th-hour pain scores, total analgesic consumption, and time to first rescue analgesic

Inclusion criteria

• Pediatric male patients aged 1-7 years.
• ASA (American Society of Anesthesiologists) physical status I or II.
• Scheduled for elective hypospadias surgery.
• Written informed consent obtained from parents/guardians

Exclusion criteria

• History of neurological deficit or developmental delay.
• Bleeding diathesis or known coagulopathy.
• History of allergy to local anesthetics.
• Infection or skin lesion at the block injection site.
• Congenital spinal anomaly.
• Mental retardation or history of psychiatric disease.
• Liver or kidney dysfunction