The impact on postoperative complications and analgesia of different nerve block techniques after hypospadias repair: a network meta-analysis

Abstract

Abstract Hypospadias is the most common congenital anomaly of the genitourinary system, and hypospadias repair is one of the most common urological surgeries performed. Regional anesthesia utilized for this penile reconstructive surgery is typically either caudal block(CB) or penile nerve block(PB) or pudendal nerve block(PNB), but the evidence regarding whether these techniques will increase postoperative complications is still controversial. Therefore we aimed to assess the association between block type and the incidence of postoperative complications. Relevant studies were identified by searching electronic databases, including randomized controlled trials, case-control, and cohort studies from inception until June 10th, 2023 and performed this network meta-analysis. A total of 29 studies were included, involving a population of 5284 pediatric patients. Our network meta-analysis revealed that PB may be the optimal nerve block technique to minimize postoperative complications in hypospadias repair surgery. Regarding postoperative analgesic effects, PNB ranked first to reduce consumption of postoperative analgesics, followed by PB. Therefore PB may be one of the most effective techniques to decrease complication rates in hypospadias repair, and significantly reduced reliance on postoperative analgesics of these patients. However, due to clinical and methodology heterogeneity among included studies, further validation is warranted.