Description

Hypospadias is the second most common congenital anomaly, after undescended testes, occurring approximately in 1 of every 250 newborn males. Correction surgeries are associated with many complications including inadequate control of intraoperative and postoperative pain; which can increase parenteral opioid consumption, delay recovery and decrease parental satisfaction.

Caudal block is the most common regional anesthetic technique performed in children undergoing surgery because of its simplicity, and effectiveness. A single shot caudal block with a local anesthetic agent, such as bupivacaine, is a standard procedure, and analgesia is provided during surgery but unfortunately, its action stops early in the postoperative period and has complications such as needle trauma, infection, hematoma, and accidental subarachnoid or intravascular local anesthetic injection might develop along with urinary retention and possible motor blockade.

Caudal epidural block can be performed easily because the landmarks are superficial. The landmark technique for caudal epidural in children has a high success rate but ultrasound can aid caudal epidural performance by helping identify aberrant anatomy, localizing the dural sac, and reducing the rate of dural or intravascular perforation.

Erector spinae plane (ESPB) block is an effective regional anesthesia method for postoperative analgesia in thoracic and abdominal operations because it blocks both somatic and visceral pain by injecting a local anesthetic (LA) into the interfacial space between the transverse process and the erector spinae muscle and distributing LA into several paravertebral spaces.