This arm : patients will be received pudendal nerve block by dual guidance technique ( ultrasound and neurostimulation)

This arm : patients will be received pudendal nerve block by ultrasound-guided only.

Phimosis

Pudendal nerve block is the one of peripheral nerve block. Injection local anesthetic medication around this nerve can provide analgesia around perineal area.

Pudendal nerve block

Ramathibodi Hospital

Does Neurostimulation Improve Efficacy for Ultrasound-Guided Transperineal Pudendal Nerve Block In Children

Does Neurostimulation Improve Efficacy for Ultrasound-Guided Transperineal Pudendal Nerve Block In Children: A Randomized Clinical Trial

the proportion of patients who need opioids in recovery room in each group

No increasing of blood pressure or heart rate more than 10 % of baseline before incision

Postoperative analgesics including
Fentanyl : unit is microgram
paracetamol : milligrams

Time (in hours) that patients received the first analgesic medications.

use Face Legs Activity Cry Consolability scale patients will be assessed by FLACCs , 6 times
In recovery room : will assess every 15 minutes, 4 times
Time at Arriving the ward
6 hours after arriving the ward
FLACC score (score 1-10, minimum is 1, maximum is 10) FLACC score >3 , patients will be received fentanyl 0.5 micrograms/kilogram

Patients will be assessed by PPPM-SF by parents every 6 hours PPPM-SF (score 1-10, minimum is 1, maximum is 10) score > 1 , patients will be received paracetamol 15 milligrams/ kilogram

Time spent for performing pudendal nerve block ( minutes)

incidence of :
vaacular puncture
rectal puncture
internal organ injury
local anesthetic toxicity
voiding difficulty

Parental satisfaction score : scoring from 1-5 ( 1 = unsatisfied, 5=the most satisfied)

Witchaya Supaopaspan

Principal investigator

Maharaj Nakorn Chiang Mai Hospital

164 Boys for Hypospadias Surgery Under General Anesthesia With Caudal Block

Technique performance (Caudal block): classical technique; palpation, identification and puncture with the patients in the lateral position (permits easy access to the airway under general anesthesia) using a 22‐G short‐beveled needle under sterile conditions advancing needle pierces the sacrococcygeal ligament.
After needle insertion, pre-calculated volume of Levob plus DEXM bolus was injected as follow; Group A Caudal Levob 0.125%+ DEXM 0.5µg/kg. Group B Caudal Levob 0.125%+ DEXM 1µg/kg. Group C Caudal Levob 0.125%+ DEXM 1. 5 µg/kg. Group D Caudal Levob 0.125%+ DEXM 2µg/kg.

Caudal dexamedatomidine analgesia

Caudal Dexmedetomidine Analgesia in Pediatrics .

The Analgesic Effectiveness and Safety of Upgraded Caudal Dexmedetomidine Doses in Pediatric Hypospadias Surgery.

time from full recovery till child express moderate pain OPS 4 and ask for the first analgesic dose

hypospadias/astenia

Does Neurostimulation Improve Efficacy for Ultrasound-Guided Transperineal Pudendal Nerve Block In Children

Caudal Dexmedetomidine Analgesia in Pediatrics .

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