Type of analgesic block not related to incidence of complications after hypospadias surgery

The study was conducted to examine the association between type of analgesic block and incidence of complications following primary hypospadias correction.

Data sources included MEDLINE, Embase, Web of Science and the Cochrane Library, inception-01/2021. Randomized clinical trials, cohort and case-control studies reporting original data for patients <18 years of age undergoing primary hypospadias correction with either a penile or caudal block for which outcomes (urethrocutaneous fistula or glans dehiscence) were reported. Two researchers independently extracted data and assessed quality for inclusion. The primary outcome was the incidence of complication within 1-year post-operatively based on block performed.

Results of the study are:

Ten studies (3201 patients; range: 54-983) were included. Six studies (cumulative weight 28.6%) favored penile block while 4 studies (cumulative weight 71.4%) favored caudal block. Compared to the reference group of penile blocks, caudal blocks had no significant association with development of complications following primary hypospadias correction (relative risk 1.11, 95% CI (0.88, 1.41); p=0.38). When adjusting for meatal location (distal vs. proximal) there was no significant association with the development of fistulae or glanular dehiscence following primary hypospadias correction with caudal blocks in comparison to the reference group, penile blocks for distal, (relative risk 1.46, 95%CI (0.98, 2.17); p=0.065) and proximal (relative risk 0.95, 95% CI (0.58, 1.54); p=0.823).

Thus, the type of analgesic block is not associated with the risk of developing complications following primary hypospadias correction in children. However Caudal block should be considered for these urological interventions.

Reference:

Association of analgesic block with the incidence of complications following hypospadias surgery; a meta-analysis by Adam C. Adler et al. published in the Urology.

https://www.goldjournal.net/article/S0090-4295(22)00209-6/fulltext?dgcid=raven_jbs_aip_email#%20