Caudal vs. Pudendal Block in Peds GU
Caudal vs. Pudendal Block for Early Postoperative Pain Control in a Pediatric Population Undergoing Lower Genitourinary Surgery
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Study Type
Study Type
Phase
Phase
- Phase 4
Contacts and Locations
Study Locations
-
-
Ohio
-
Cleveland, Ohio, United States, 44106
- UH Rainbow Babies and Children's Hospital
-
-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Undergoing penile genitourinary surgery
- ASA class 1-3
Exclusion Criteria:
- Female patients
- Male children <6 months or >/= 3 years of age
- ASA class >3
- Surgery at satellite location (non-Prentiss)
- Concurrent non-lower GU tract surgery
- Sacrospinal abnormality
- History of chronic pain requiring opioid analgesics
- Inability to tolerate and receive acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), alpha-2 agonists, or local anesthetics
- History of malignant hyperthermia
- History of coagulopathy
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Active Comparator: Caudal Block
Patients will receive a caudal block prior to surgery.
|
Injectable 1 ml/kg of 0.25% ropivacaine with 1mcg/kg dexmedetomidine into caudal spinal space.
First attempt will be landmark-guided into the caudal spine region.
Subsequent attempt(s) may be done using ultrasound.
Injectable 1 ml/kg of 0.25% ropivacaine with 1mcg/kg dexmedetomidine into caudal spinal space.
First attempt will be landmark-guided into the caudal spine region.
Subsequent attempt(s) may be done using ultrasound.
|
|
Experimental: Pudendal Block
Patients will receive a pudendal block prior to surgery.
|
Injection of 0.5 ml/kg per side of injectable 0.2-0.3%
ropivacaine with 0.5 mcg/kg dexmetomedine.
Ultrasound-guided injection into each pudendal nerve region through skin of buttocks.
Injection of 0.5 ml/kg per side of injectable 0.2-0.3%
ropivacaine with 0.5 mcg/kg dexmetomedine.
Ultrasound-guided injection into each pudendal nerve region through skin of buttocks.
|
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Rescue Narcotic Administration
Time Frame: During post-operative in-hospital recovery, approximately 1 hour
|
Dose (mg) of postoperative rescue opioid
|
During post-operative in-hospital recovery, approximately 1 hour
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Non-Narcotic Rescue Administration at 24 hours
Time Frame: During first day after surgery, approximately 24 hours
|
Dose (mg) of non-narcotic rescue medication
|
During first day after surgery, approximately 24 hours
|
|
Non-Narcotic Rescue Administration at 48 hours
Time Frame: During second day after surgery, approximately 48 hours
|
Dose (mg) of non-narcotic rescue medication
|
During second day after surgery, approximately 48 hours
|
|
Non-Narcotic Rescue Administration at 72 hours
Time Frame: During third day after surgery, approximately 72 hours
|
Dose (mg) of non-narcotic rescue medication
|
During third day after surgery, approximately 72 hours
|
|
Number of participants with at least one adverse event (AE) as measured by patient report
Time Frame: End of study, up to 3 months
|
Adverse events will include any AE related to study procedure
|
End of study, up to 3 months
|
Collaborators and Investigators
Sponsor
Sponsor
Investigators
Investigators
- Principal Investigator: Jessica H Hannick, MD, MSc, University Hospitals Cleveland Medical Center
Publications and helpful links
General Publications
- Kendigelen P, Tutuncu AC, Emre S, Altindas F, Kaya G. Pudendal Versus Caudal Block in Children Undergoing Hypospadias Surgery: A Randomized Controlled Trial. Reg Anesth Pain Med. 2016 Sep-Oct;41(5):610-5. doi: 10.1097/AAP.0000000000000447.
- Naja ZM, Ziade FM, Kamel R, El-Kayali S, Daoud N, El-Rajab MA. The effectiveness of pudendal nerve block versus caudal block anesthesia for hypospadias in children. Anesth Analg. 2013 Dec;117(6):1401-7. doi: 10.1213/ANE.0b013e3182a8ee52.
- Gaudet-Ferrand I, De La Arena P, Bringuier S, Raux O, Hertz L, Kalfa N, Sola C, Dadure C. Ultrasound-guided pudendal nerve block in children: A new technique of ultrasound-guided transperineal approach. Paediatr Anaesth. 2018 Jan;28(1):53-58. doi: 10.1111/pan.13286. Epub 2017 Dec 5.
- Wren AA, Ross AC, D'Souza G, Almgren C, Feinstein A, Marshall A, Golianu B. Multidisciplinary Pain Management for Pediatric Patients with Acute and Chronic Pain: A Foundational Treatment Approach When Prescribing Opioids. Children (Basel). 2019 Feb 21;6(2):33. doi: 10.3390/children6020033.
- Vargas A, Sawardekar A, Suresh S. Updates on pediatric regional anesthesia safety data. Curr Opin Anaesthesiol. 2019 Oct;32(5):649-652. doi: 10.1097/ACO.0000000000000768.
- Wiegele M, Marhofer P, Lonnqvist PA. Caudal epidural blocks in paediatric patients: a review and practical considerations. Br J Anaesth. 2019 Apr;122(4):509-517. doi: 10.1016/j.bja.2018.11.030. Epub 2019 Feb 1.
- Okoro C, Huang H, Cannon S, Low D, Liston DE, Richards MJ, Lendvay TS. The pudendal nerve block for ambulatory urology: What's old is new again. A quality improvement project. J Pediatr Urol. 2020 Oct;16(5):594.e1-594.e7. doi: 10.1016/j.jpurol.2020.07.025. Epub 2020 Jul 24.
- Shah UJ, Nguyen D, Karuppiaah N, Martin J, Sehmbi H. Efficacy and safety of caudal dexmedetomidine in pediatric infra-umbilical surgery: a meta-analysis and trial-sequential analysis of randomized controlled trials. Reg Anesth Pain Med. 2021 May;46(5):422-432. doi: 10.1136/rapm-2020-102024. Epub 2021 Jan 15.
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Estimated)
Primary Completion
Study Completion (Estimated)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Urogenital Abnormalities
- Congenital Abnormalities
- Penile Diseases
- Female Urogenital Diseases
- Female Urogenital Diseases and Pregnancy Complications
- Urogenital Diseases
- Male Urogenital Diseases
- Genital Diseases, Male
- Genital Diseases
- Hypospadias
- Phimosis
- Physiological Effects of Drugs
- Adrenergic Agents
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Central Nervous System Depressants
- Peripheral Nervous System Agents
- Analgesics
- Sensory System Agents
- Anesthetics
- Analgesics, Non-Narcotic
- Adrenergic alpha-2 Receptor Agonists
- Adrenergic alpha-Agonists
- Adrenergic Agonists
- Hypnotics and Sedatives
- Anesthetics, Local
- Dexmedetomidine
- Ropivacaine
Other Study ID Numbers
Other Study ID Numbers
- STUDY20220033
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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