Does Caudal Block Increase the Incidence of Urethrocutaneous Fistula Formation Following Hypospadias Repair in Infants?

NCT ID: NCT02861950

Last Updated: 2024-07-01

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

165 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-05-24

Study Completion Date

2023-09-20

Brief Summary

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This is a prospective randomized multi-center non-inferiority trial conducted through the Pediatric Regional Anesthesia Network study sites to determine if caudal block increases the incidence of urethrocutaneous fistula following distal or mid shaft hypospadias repair compared with penile nerve block.

Detailed Description

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Small retrospective series are in conflict about whether there is an association between caudal block and urethrocutaneous fistulas after hypospadias repair. The most common alternative to caudal blockade is a penile nerve block. The investigators will test the following hypothesis:

There is no difference in the incidence of urethrocutaneous fistula formation following single stage hypospadias repair with caudal anesthesia compared with penile nerve block.

The investigators will use a prospective randomized controlled design where subjects will receive either a caudal block or a penile nerve block to provide postoperative analgesia. Meatal anatomy will be graded by the urologist in the anesthetized child according to the HOPE (Hypospadias Objective Penile Evaluation) score, a validated scoring system. Both the total score and the individual component scores will be recorded. The operating urologist will determine the presence or absence of a fistula at the postoperative visit about 12 weeks after surgery, with subsequent follow up at 6 months and again at 12 months.

Conditions

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Hypospadias Urethrocutaneous Fistula

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Caudal block

Patients will receive a caudal block with 0.75-1ml/kg of 0.2% ropivacaine.

Group Type ACTIVE_COMPARATOR

Caudal block with ropivacaine

Intervention Type DRUG

Patients in this arm will receive a caudal block with ropivacaine

Penile Nerve Block

Patients will receive a dorsal penile nerve block with up to 0.75ml/kg of 0.25% bupivacaine.

Group Type ACTIVE_COMPARATOR

penile nerve block with bupivacaine

Intervention Type DRUG

Patients in this arm will receive a penile block with bupivacaine

Interventions

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Caudal block with ropivacaine

Patients in this arm will receive a caudal block with ropivacaine

Intervention Type DRUG

penile nerve block with bupivacaine

Patients in this arm will receive a penile block with bupivacaine

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* infants/ children with midshaft or distal hypospadias undergoing primary single stage repair in one of the Pediatric Regional Anesthesia Network participating centers.

Exclusion Criteria

* prior hypospadias surgery,
* proximal or penoscrotal hypospadias,
* abnormal caudal anatomy or spinal dysraphism,
* cyanotic congenital heart disease,
* infection or rash at the block injection site.
Minimum Eligible Age

4 Months

Maximum Eligible Age

2 Years

Eligible Sex

MALE

Accepts Healthy Volunteers

No

Sponsors

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Stanford University

OTHER

Sponsor Role collaborator

Dartmouth-Hitchcock Medical Center

OTHER

Sponsor Role collaborator

Boston Children's Hospital

OTHER

Sponsor Role collaborator

Children's Medical Center of Dallas/UT Southwestern

UNKNOWN

Sponsor Role collaborator

University of Mississippi Medical Center

OTHER

Sponsor Role collaborator

University of New Mexico

OTHER

Sponsor Role collaborator

University of Michigan

OTHER

Sponsor Role collaborator

Children's National Research Institute

OTHER

Sponsor Role collaborator

University of Wisconsin, Madison

OTHER

Sponsor Role collaborator

University of Colorado, Denver

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Megan Brockel, MD

Role: PRINCIPAL_INVESTIGATOR

University of Colorado, Denver

Locations

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Children's Hospital Colorado

Aurora, Colorado, United States

Site Status

Countries

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United States

Other Identifiers

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15-2343

Identifier Type: -

Identifier Source: org_study_id

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