Paediatric regional anaesthesia and peripheral nerve blocks in paediatric outpatient surgery. Prospective, single-center, pragmatic comparative cohort study

BACKGROUND: Adequate perioperative analgesia is a key component of paediatric urologic surgery. Several regional anaesthesia techniques are commonly used for inguinal and genital procedures; however, prospective comparative data across different block types remain limited. METHODS: This prospective, single-center, pragmatic comparative cohort study included 160 children undergoing outpatient inguinal or genital urologic surgery. Regional anesthesia was provided using caudal block (CB), quadratus lumborum block (QLB), pudendal block (PDB), or penile block (PB) (n = 40 per group), allocated in a procedure-driven, non-randomized manner reflecting routine clinical practice and the personal experience already gained. Primary outcomes were intraoperative opioid requirements and postoperative pain scores at 1, 6, and 24 h. Secondary outcomes included time first to rescue analgesic, postoperative analgesic consumption, post-anaesthesia care unit stay, time to return to regular activity, and block-related complications. RESULTS: For inguinal procedures, CB and QLB demonstrated comparable analgesic effectiveness; CB was associated with lower intraoperative opioid use, while QLB showed a trend toward lower early postoperative pain scores. In genital procedures, PB was associated with higher pain scores, increased rescue analgesic requirements, earlier need for rescue analgesia, and longer recovery time compared with CB and PDB (p < 0.001). No block-related complications were observed. CONCLUSION: In this prospective pragmatic cohort, all regional anaesthesia techniques demonstrated acceptable short-term safety. Within procedure-specific comparisons, QLB showed a trend toward improved early analgesia in inguinal surgery, while PDB was associated with more consistent early analgesia than PB in genital procedures. Given the non-randomized design, these findings should be considered exploratory and support a procedure-specific approach to regional block selection in paediatric urologic surgery.