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Hypospadias surgery is associated with acute postoperative pain needing long-term analgesia. Regional anaesthesia is commonly used with general anaesthesia (GA). We aim to compare sacral erector spinae plane block (ESPB) caudal and penile blocks in pain management following hypospadias surgery. This randomized controlled single blind trial was established on 132 pediatric cases aged from 1 to 5 years, American Society of Anesthesiologists (ASA) physical status I-II, planned for hypospadias surgery. Cases were classified into three equal groups; group C: received caudal block (CB) (1 ml/kg bupivacaine 0.25%, maximum 20 ml), group P: received penile block (0.1 ml/kg bupivacaine 0.5%, maximum 2.5 ml) and finally, group E: received ultrasound guided sacral bilateral ESPB (1 mL/kg 0.25% bupivacaine, maximum 20 ml). The blocks were done after GA induction and before the surgical incision. Time to 1 st  rescue analgesia was significantly delayed in groups C and E than group P ( P  &lt; 0.001) and was insignificantly different between groups C and E. Total pethidine consumption was significantly lower in groups C and E than group P ( P  = 0.003, and 0.028, respectively). FLACC scores were significantly lower in groups C and E than group P at 4, 6, 8 and 12 h ( p  &lt; 0.05) and were insignificantly different between groups C and E. Penile engorgement was insignificantly different among the three groups. Both ESPB and CB had better pain control and lower opioid consumption compared to penile block, but CB is associated with incidence with penile engorgement and hypotensiveness than other techniques.

Analgesic effect of sacral erector spinae, penile and caudal block after hypospadias surgery: A randomized single blind controlled trial