Comparing Pudendal Nerve Blocks and Caudal Blocks for Pediatric Urological Surgeries: A Systematic Review and Meta-Analysis

Pudendal nerve blocks (PNBs) and caudal blocks (CBs) are commonly used regional anesthesia techniques in pediatric urological surgeries. This systematic review and meta-analysis aimed to compare the efficacy and safety of PNBs versus CBs in this patient population. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive search was conducted in PubMed, Scopus, and Cochrane CENTRAL to identify studies comparing PNBs and PBs in pediatric urological surgeries. Eligible studies included randomized controlled trials and observational studies assessing postoperative pain scores, duration of analgesia, and complication rates. Data extraction and risk-of-bias assessments were performed independently by two reviewers. Statistical analyses were conducted using Review Manager version 5.4 (RevMan; Computer program. Version 5.4. The Cochrane Collaboration, 2020). Seven studies, comprising 644 pediatric patients, were included. PNBs significantly reduced postoperative pain scores at 6, 12, and 24 hours compared to CBs, with mean differences of -1.83, -2.10, and -2.94, respectively. PNBs also prolonged analgesia duration and reduced opioid consumption. The incidence of urinary retention and the need for rescue analgesia were lower in the PNB group. No significant differences were observed in motor block or systemic side effects. PNBs offer superior pain relief and reduce opioid consumption and complications compared to CBs in pediatric urological surgeries. These findings support the integration of PNBs into clinical practice as an effective regional anesthesia technique. Further research is needed to confirm these results and optimize pain management strategies in pediatric patients.