الفهرس 
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Abstract
Hypospadias is the second most common congenital disorder in males after cryptorchidism, but it is the most common penile congenital malformation. It is an abnormality of anterior urethral and penile development in which the urethral opening is ectopically located on the ventral aspect of the penis proximal to the tip of the glans penis, which, in this condition, is splayed open. The urethral opening may be located as far down as in the scrotum or perineum. The penis is more likely to have associated ventral shortening and curvature, called chordee, with more proximal urethral defects.
Hypospadias repair can be performed under general anesthesia, or regional anesthesia. Caudal block and DPNB are commonly used regional anesthesia methods to provide effective postoperative pain control in hypospadias repair.
The aim of the study was to compare the effectiveness of penile block versus caudal block using bupivacaine on the quality of analgesia after hypospadias repair in pediatrics.
The study was conducted on 30 randomly chosen children in Ain Shams University Hospitals after approval of the medical ethical committee. Patients were divided randomly into two groups, each group consisted of 15 patients group C and group P.
After preoperative assessment and obtaining baseline vital data, all patients received general anesthesia. Patients in the group C received caudal block (0.5 ml/kg of bupivacaine 0.25%). Patients in the group P received penile block (total dose of 1ml/kg of 0.25% bupivacaine).
The two groups were adequately monitored and assessed post-operatively and they were compared regarding demographic data, hemodynamics, post-operative pain control using FLACC pain score in the 1st 12hrs, time for first rescue analgesia, total analgesic consumption and post-operative time of ambulation.
Postoperative pain was evaluated by FLACC pain score at PACU, 3, 6, 9 and 12 hrs. It was significantly lower in group C compared with group P (P=0.018) at PACU and (P<0.001) at 3 hrs. Also, the time for first rescue analgesia was significantly lower in group C (165.33 ± 16.4 min) compared with group P (99.67 ± 15.52 min) (P > 0.001).The total analgesic consumption was also significantly lower in group C (paracetamol 32 ± 12.5 mg/kg) (pethidine 1.1 ± 0.8 mg/kg) than group P (paracetamol 65 ± 16.7 mg/kg) (pethidine 2.9 ± 0.7 mg/kg) (P < 0.001). Postoperative time of ambulation was significantly lower in group P (3.87 ± 0.64 hrs) compared with group C (6.27 ± 0.96 hrs) (P < 0.001).
This current study revealed also that there was high statistically significant difference between two groups regarding hemodynamics including MAP (P<0.001) and HR (P<0.001) but no statistically significant difference between them in SP02.