Çocuklarda Ürogenital Cerrahi Sonrası Analjezide Landmark Kılavuzlu Pudendal Sinir Bloğu ile Penil Bloğun Karşılaştırılması: Retrospektif Kohort Çalışması

Öz

Pediatrik ürogenital cerrahi geçiren hastalarda postoperatif ağrı kontrolü, optimal perioperatif yönetimin temel bileşenlerinden biridir. Pudendal sinir bloğu ve penil blok yaygın kullanılan bölgesel teknikler olmakla birlikte, özellikle landmark kılavuzlu yaklaşımlara ilişkin karşılaştırmalı veriler sınırlıdır. Bu nedenle, bu çalışmada bilateral pudendal sinir bloğu ile penil bloğun analjezik etkinliği karşılaştırılmıştır. Ocak 2024 – Kasım 2025 tarihleri arasında genel anestezi altında elektif ürogenital cerrahi geçiren 2–10 yaş arası çocuklar retrospektif olarak incelendi. Hastalar uygulanan blok tipine göre iki gruba ayrıldı. Postoperatif ağrı FLACC skoru ile değerlendirildi. Analjezik tüketimi ve kurtarıcı analjezi gereksinimi kaydedildi. Toplam 99 hasta değerlendirildi (PDB:45, PNB:54). 6. saatte FLACC skoru PDB grubunda daha düşüktü (0.84±1.15 vs 1.72±1.37, p<0.001). Toplam parasetamol tüketimi ve kurtarıcı analjezi ihtiyacı PDB grubunda daha azdı. Bu retrospektif kohort çalışmada, landmark kılavuzlu bilateral pudendal sinir bloğu, pediatrik ürogenital cerrahide postoperatif 6. saatte daha düşük ağrı skorları ve daha düşük analjezik tüketimi ile ilişkili bulunmuştur.

Anahtar Kelimeler

• Pudendal sinir bloğu
• bölgesel anestezi
• penil blok
• postoperatif ağrı
• pediatrik cerrahi

Destekleyen Kurum

Yok

Etik Beyan

Bu çalışma, Muğla Sıtkı Koçman Üniversitesi Tıp ve Sağlık Bilimleri Araştırma Etik Kurulu tarafından onaylanmıştır (Karar no: 66, Protokol no: 250065, Tarih: 25.12.2025).

Teşekkür

Yazarlar, Muğla Eğitim ve Araştırma Hastanesi cerrahi servis ve postanestezi bakım ünitesi (PACU) hemşirelerine, özverili postoperatif hasta bakımları ve doğru ile eksiksiz klinik kayıtların tutulmasına katkılarından dolayı teşekkür eder.

Landmark-Guided Pudendal Nerve Block versus Penile Block for Postoperative Analgesia in Paediatric Urogenital Surgery: A Retrospective Cohort Study

Öz

Postoperative pain control is a fundamental component of optimal perioperative management in patients undergoing paediatric urogenital surgery. Although pudendal nerve block and dorsal penile block are commonly used regional techniques, comparative data—particularly for landmark-guided approaches—remain limited. Therefore, this study aimed to compare the analgesic effectiveness of bilateral pudendal nerve block and dorsal penile block. This retrospective cohort study included children aged 2–10 years who underwent elective urogenital surgery under general anaesthesia between January 2024 and November 2025. Patients were grouped according to the regional block technique documented in the anaesthesia records: bilateral landmark-guided pudendal nerve block (PDB) or penile nerve block (PNB). Postoperative pain was assessed using the FLACC scale in the post-anaesthesia care unit and at 2, 6, 12 and 24 hours. Total paracetamol consumption and rescue analgesia were recorded. Ninety-nine patients were analysed (PDB: 45; PNB: 54). FLACC scores were lower in the PDB group at 6 hours (0.84±1.15 vs 1.72±1.37, p<0.001). Total paracetamol consumption was lower in the PDB group (109.6±73.9 mg vs 188.3±85.4 mg, p<0.001), and fewer patients required rescue analgesia (53.3% vs 74.1%, p=0.03).  In this retrospective cohort study, landmark-guided bilateral pudendal nerve block was associated with lower postoperative pain scores at 6 hours and reduced analgesic consumption compared with dorsal penile block in paediatric urogenital surgery.

Anahtar Kelimeler

• Pudendal nerve block
• penile block
• postoperative pain
• pediatric surgery

Destekleyen Kurum

None

Etik Beyan

The study was approved by the Muğla Sıtkı Koçman University Medical and Health Sciences Research Ethics Committee (Decision no: 66, Protocol no: 250065, Date: 25.12.2025).

Teşekkür

The authors thank the surgical ward and postanesthesia care unit (PACU) nursing staff of Mugla Training and Research Hospital for their dedicated postoperative patient care and for maintaining accurate and complete clinical records.

Kaynakça

1. 1. Walker SM. Pain after surgery in children: clinical recommendations. Curr Opin Anaesthesiol. 2015;28:570-6.
2. 2. Vittinghoff M, Lönnqvist PA, Mossetti V, et al. Postoperative pain management in children: guidance from the Pain Committee of the European Society for Paediatric Anaesthesiology. Paediatr Anaesth. 2018;28:493-506.
3. 3. Batoz H, Semjen F, Bordes-Demolis M, et al. Chronic postsurgical pain in children: prevalence and risk factors. Br J Anaesth. 2016;117:489-96.
4. 4. Cyna AM, Middleton P. Caudal epidural block versus other methods of postoperative pain relief for circumcision in boys. Cochrane Database Syst Rev. 2008;CD003005.
5. 5. Okoro C, Cannon S, Low D, Lendvay TS. How I do it: the pudendal nerve block for pediatric ambulatory urologic surgery. Can J Urol. 2021;28:10648-51.
6. 6. Ecoffey C. Penile block for circumcision in children. BJA Educ. 2016;16:345-9.
7. 7. Boisvert-Moreau F, Turcotte B, Albert N, et al. Ultrasound-guided pudendal nerve block vs ultrasound-guided penile nerve block for pediatric circumcision. Reg Anesth Pain Med. 2023;48:127-33.
8. 8. Bendtsen TF, Parras T, Moriggl B, et al. Ultrasound-guided pudendal nerve block at the entrance of the pudendal (Alcock) canal: description of anatomy and clinical technique. Reg Anesth Pain Med. 2016;41:140-5.

9. 9. Gaudet-Ferrand I, De La Arena P, Bringuier S, et al. Ultrasound-guided pudendal nerve block in children: transperineal approach. Paediatr Anaesth. 2018;28:53-8.
10. 10. Naja ZM, Al-Tannir MA, Faysal W, et al. Pudendal block versus dorsal penile nerve block for circumcision in children. Anaesthesia. 2011;66:802-7.
11. 11. Tutuncu AC, Kendigelen P, Ashyyeralyeva G, et al. Pudendal nerve block versus penile nerve block in children undergoing circumcision. Urol J. 2018;15:109-15.
12. 12. Aksu C, Akay MA, Sen MC, Gurkan Y. Ultrasound-guided dorsal penile nerve block vs neurostimulator-guided pudendal nerve block in hypospadias surgery. Paediatr Anaesth. 2019;29:1046-52.
13. 13. Peng T, Qu S, Du Z, et al. A systematic review of the measurement properties of Face, Legs, Activity, Cry and Consolability scale for pediatric pain assessment. J Pain Res. 2023;16:1185-96.
14. 14. Pizzinato A, Liguoro I, Pusiol A, et al. Detection and assessment of postoperative pain in children with cognitive impairment: a systematic review and meta-analysis. Eur J Pain. 2022;26:965-79.
15. 15. Oliver JA, Oliver LA, Aggarwal N, et al. Ambulatory pain management in the pediatric patient population. Curr Pain Headache Rep. 2022;26:15-23.
16. 16. Long RM, McFarlane J, O’Brien M. A preliminary study of the sensory distribution of the penile dorsal and ventral nerves: implications for effective penile block for circumcision. BJU Int. 2010;105:1576-8.
17. 17. Tsui BC, Suresh S. Ultrasound imaging for regional anesthesia in infants, children, and adolescents: a review of current literature and its application in the practice of neuraxial blocks. Anesthesiology. 2010;112:719-28.
18. 18. Walker BJ, Long JB, Sathyamoorthy M, et al. Complications in pediatric regional anesthesia: an analysis of more than 100,000 blocks from the Pediatric Regional Anesthesia Network. Anesthesiology. 2018;129:721-32.
19. 19. Marhofer P, Willschke H, Kettner SC. Pediatric regional anesthesia: current concepts and practical considerations. Anesthesiology. 2025;143:444-61.