Caudal analgesia (CA) is a widely used method to tackle pain after hypospadias repair. Complications related to temporary penile engorgement has made people concerned about CA and switch to pudendal analgesia (PA). In this prospective randomized blinded study we compared CA and PA among children undergoing hypospadias repair. We hypothesized that pudendal analgesia would be equally effective as caudal analgesia, with no altered risk of surgical complications.

All children undergoing single-stage distal hypospadias repair were randomized into CA or PA groups. In both groups, analgesia was provided under ultrasound guidance with 0.2% ropivacaine and 1 mcg/kg clonidine. FLACC score (Face, Leg, Anxiety, Crying, Consolability) for pain and urethroplasty complications were compared between the groups.

During the study period, a total 72 patients were recruited (36 in each group). There was no significant difference between the groups in terms of FLACC score.Rescue analgesia was required in 2/36 (5%) in CA and 3/36(8%) in PA with no significant difference (p = 1). Post-operative complications were encountered in 4/36 (11.1%) in CA (1 glans dehiscence, 2 fistulae, 1 partial skin-flap necrosis) while 3/36 (8.3%) in PA group (1 glans dehiscence, 2 fistulae) with no significant difference (p = 1).

There was no difference between CA and PA in terms of analgesic effects or postoperative complications. While PA is as effective in pain relief, conventional CA is not associated with higher complications. Further larger studies are warranted comparing penile, caudal and pudendal blocks in hypospadias.