SummaryBackground: Children undergoing hypospadias repair need to be protected from highly unpleasant sensory and emotional experiences during and after surgery. We designed a double‐blinded, randomized, and placebo‐controlled study to compare the efficacy of a low‐dose (2 μg·kg−1) of intrathecal morphine with placebo for postoperative pain control of children undergoing repair of hypospadias surgery with spinal anesthesia.Methods: Fifty‐four children were randomly assigned to one of two spinal anesthesia groups. Group M (n = 27) received hyperbaric bupivacaine plus 2 μg·kg−1 of preservative‐free morphine and group P (n = 27) received hyperbaric bupivacaine plus 0.9% NaCl (placebo) under inhalation anesthesia. General anesthetics were discontinued subsequent to the block. The primary outcome was the presence of pain‐requiring analgesics during the first 12 h after the spinal block. Side effects were also recorded. The analgesic effects were evaluated by using the Children’s Hospital of Eastern Ontario Pain Scale.Results: Forty‐nine patients completed the trial. Fifteen patients (60%) in group P received supplementary analgesics within the first 12 h compared to only four patients (16.7%) in group M (P = 0.005). Mean duration of analgesia was 480 ± 209 and 720 ± 190 min in group P and group M respectively (P = 0.009). The groups were similar in postoperative side effects.Conclusion: Spinal anesthesia provided by hyperbaric bupivacaine is adequate for distal hypospadias repair in children, but adding 2 μg·kg−1 intrathecal morphine provides better postoperative pain control when compared to placebo in these children.

BACKGROUND:In adults, pencil point spinal needles are known to be less traumatic and hence to be superior compared with cutting point needles in respect of postpuncture complications. In children, only a few trials have evaluated the difference in the incidence of postdural puncture headache (PDPH) using spinal needles with different tip designs. The aim of this study was to evaluate the success rate and the incidence of PDPH and backache following spinal anesthesia (SA) with the two types of needles currently in use for children. METHODS:This is a retrospective study of prospectively collected data. The success rate and postpuncture complications of 26G cutting point (Atraucan) spinal needle were compared with 27G pencil point (Pencan) spinal needle in 414 children aged 2-17 years undergoing surgery with SA. RESULTS:Both needles had similar first-attempt success rates: 87% in the cutting point group and 91% in the pencil point group (P = 0.16). Pencil point needles caused less PDPH compared to cutting point needles; 0.4% vs 4.5%, respectively (P = 0.005). Both needles caused similar backache (P = 0.08). No severe neurologic symptom was reported for both needles. CONCLUSION:The data suggest that 27G pencil point spinal needles lead to less PDPH compared to 26G cutting point spinal needles in children.