HypospadiasPhase 3NCT07197203
Comparison of Caudal Block and Sacral Erector Spinae Plane Block With Dexmedetomidine in Pediatric Penile Hypospadias Repair
A Phase 3 study testing Sacral ESP Block and Caudal epidural block in people with Hypospadias, run by Assiut University.
Trial summary
Hypospadias is one of the most common congenital anomalies in childhood, requiring surgical reconstruction (1). It is a penile malformation with a more proximal or ventral location beyond the usual localization of the urethra. Read more about this study
- Who is it for?
- Ages 1 year to 6 years, men only
- Conditions the study is for
- Hypospadias
- What is being tested?
- Sacral ESP Block and Caudal epidural block
- Type of treatment
- Injection or infusion, Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 66 participants
- Where
- No sites listed yet
- Study dates
- 1 Oct 2025to 1 Dec 2026
- Phase
- Phase 3
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 1 year to 6 years
- Men only
- No healthy volunteers
- Child
Who may be able to join
- pediatric patients, aged 1-6 years, ASA physical statusI- II, scheduled for elective hypospadias repair surgery under general anesthesia.
Who cannot join
- • Parental refusal.
- Allergy to local anesthetics or dexmedetomidine.
- Coagulation disorders.
- Local infection at the site of injection.
- Anatomical abnormalities (e.g., spina bifida, sacralmalformations).
- Neurological disease.
About this study
Hypospadias is one of the most common congenital anomalies in childhood, requiring surgical reconstruction (1). It is a penile malformation with a more proximal or ventral location beyond the usual localization of the urethra. Hypospadias is a common congenital urogenital anomaly in male children, and its incidence is reported to be approximately one in every 300 births. However, it is suggested that hypospadias may increase in developed countries (2, 3). Postoperative pain management followinghypospadias repair is of great importance, as inadequatepain control may lead to adverse endocrine, metabolic, and inflammatory stress responses, resulting in higher morbidity and poor recovery(4).
Regional anesthesia has gained increasing attention in pediatric surgery as a valuable tool for managing perioperative pain and improving surgical outcomes(5). The caudal epidural block has long been considered the gold standard technique fo infraumbilical surgeries, including hypospadias repair, due to its proven efficacy and safety (4). However, its limitations include a relatively short durationof analgesia, the need for larger local anesthetic volumes, and potential adverse effects such as motor block, urinary retention, and inadvertent dural puncture. These drawbacks have led anesthesiologists to explore alternative regional techniques(6-8) Recently, the sacral erector spinae plane (ESPB) block has been introduced as a novel technique for postoperative analgesia in children(9, 10). It is an emerging regional anesthetic technique with significant potential for clinical benefit Nevertheless, its exact mechanism(s) of action have been much debated. These mechanisms include neural blockade and central inhibition from direct spread of local anesthetic to the paravertebral or epidural space, and analgesia mediated by elevated local anesthetic plasma concentrations due to systemic absorption(11).
Read more
Evidence suggests sacral ESP block can give excellent analgesia in surgical procedures (12-14). Few studies have examined its use to alleviate acute pain after hypospadias surgery (15, 16). There is a lack of data on the postoperative analgesic efficacy in hypospadias surgery.
The addition of adjuvant agents to local anesthetics has been shown to enhance the quality and duration of regiona anesthesia(17).
Dexmedetomidine, an alpha-2 adrenergic agonist, has gained significant attention for its sedative, analgesic, and anxiolytic properties in pediatric anesthesia(18).
Dexmedetomidine, a highly selective α 2- α 2-adrenergic agonist, has demonstrated sedative and analgesic properties without significant respiratory depression, making it particularly attractive in pediatric anesthesia. When used as an adjuvan to local anesthetics, dexmedetomidine prolongs block duration and reduces rescue analgesic requirements(17).
Despite the established role of caudal block and the emerging potential of sacral ESPB, there is a lack of randomized controlled trials directly comparing their analgesic efficacy in pediatric patients when combined with dexmedetomidine
- Conditions
- Hypospadias
- Being tested
- Sacral ESP Block, Caudal epidural block
- Medical subject headings
- Hypospadias
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Sacral ESP BlockProcedure or surgery
- Position: Prone with a pillow under the pelvis.
- Ultrasound: High-frequency linear probe placed parasagittal, 1-1.5 cm lateral to the midline at S2-S3. Structure identified: skin → subcutaneous tissue → erector spinae muscle → sacral lamina.
- Technique: An echogenic 22G needle will be advanced in-plane until contact with the sacral lamina under the erector spinae muscle. After hydro dissection with saline, the study drug will be injected with visible spread along the fascial plane. The same procedure will be repeated contralaterally.
- Dose: Bupivacaine 0.25% total 1 mL/kg divided equally on both sides, dexmedetomidine 1 μ g/kg divided equally.
Caudal epidural blockProcedure or surgery
- Position: Prone with a pillow under the pelvis.
- Ultrasound: High-frequency linear probe placed parasagittal, 1-1.5 cm lateral to the midline at S2-S3. Structure identified: skin → subcutaneous tissue → erector spinae muscle → sacral lamina.
- Technique: An echogenic 22G needle will be advanced in-plane until contact with the sacral lamina under the erector spinae muscle. After hydro dissection with saline, the study drug will be injected with visible spread along the fascial plane. The same procedure will be repeated contralaterally.
- Dose: Bupivacaine 0.25% total 1 mL/kg divided equally on both sides, dexmedetomidine 1 μ g/kg divided equally.
| Study group | Role | What they receive |
|---|---|---|
| Group A | Active comparator | Caudal Epidural Block Receives: Procedure: Caudal epidural block |
| Group B | Active comparator | Sacral ESP Block Receives: Procedure: Sacral ESP Block |
What is being measured
The primary outcome is the main question the study is designed to answer.
postoperative analgesia period
duration of postoperative analgesia in studied patients
Measured: 24 hours
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted29 Sep 2025
- Study start1 Oct 2025 (estimated)
- Primary completion1 Oct 2026 (estimated)
- Study completion1 Dec 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for HypospadiasStudies of the same condition, open and under way.
- More trials run by Assiut UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 3
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Quadruple blind
- Who is masked
- Participant, Care provider, Investigator, Outcomes assessor
- Enrolment
- 66 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Assiut University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Nancy Makram Gaballah, Assiut University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07197203
- Sponsor's protocol ID
- CB VS SESPB Dexmedetomidine
- Status last verified
- Sep 2025
- First submitted
- 20 Sep 2025
- Last updated
- 29 Sep 2025
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- Yes
- FDA-regulated device
- No
Study at a glance
From the registry record, last updated by the sponsor on 29 Sep 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Comparison of Caudal Block and Sacral Erector Spinae Plane Block With Dexmedetomidine in Pediatric Penile Hypospadias Repair
- ClinicalTrials.gov ID
- NCT07197203
- Acronym / sponsor ID
- CB VS SESPB Dexmedetomidine
- Conditions
- Hypospadias
- Phase
- Phase 3
- Study type
- Interventional
- Recruitment status
- Not yet recruiting
- Enrolment
- 66 participants (estimated)
- Lead sponsor
- Assiut UniversityUniversity, hospital or other
- Study start
- 1 Oct 2025 (estimated)
- Primary completion
- 1 Oct 2026 (estimated)
- Study completion
- 1 Dec 2026 (estimated)
- First posted
- 29 Sep 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Hypospadias is one of the most common congenital anomalies in childhood, requiring surgical reconstruction (1). It is a penile malformation with a more proximal or ventral location beyond the usual localization of the urethra. Hypospadias is a common congenital urogenital anomaly in male children, and its incidence is reported to be approximately one in every 300 births. However, it is suggested that hypospadias may increase in developed countries (2, 3). Postoperative pain management followinghypospadias repair is of great importance, as inadequatepain control may lead to adverse endocrine, metabolic, and inflammatory stress responses, resulting in higher morbidity and poor recovery(4).
Regional anesthesia has gained increasing attention in pediatric surgery as a valuable tool for managing perioperative pain and improving surgical outcomes(5). The caudal epidural block has long been considered the gold standard technique fo infraumbilical surgeries, including hypospadias repair, due to its proven efficacy and safety (4). However, its limitations include a relatively short durationof analgesia, the need for larger local anesthetic volumes, and potential adverse effects such as motor block, urinary retention, and inadvertent dural puncture. These drawbacks have led anesthesiologists to explore alternative regional techniques(6-8) Recently, the sacral erector spinae plane (ESPB) block has been introduced as a novel technique for postoperative analgesia in children(9, 10). It is an emerging regional anesthetic technique with significant potential for clinical benefit Nevertheless, its exact mechanism(s) of action have been much debated. These mechanisms include neural blockade and central inhibition from direct spread of local anesthetic to the paravertebral or epidural space, and analgesia mediated by elevated local anesthetic plasma concentrations due to systemic absorption(11).
Evidence suggests sacral ESP block can give excellent analgesia in surgical procedures (12-14). Few studies have examined its use to alleviate acute pain after hypospadias surgery (15, 16). There is a lack of data on the postoperative analgesic efficacy in hypospadias surgery.
The addition of adjuvant agents to local anesthetics has been shown to enhance the quality and duration of regiona anesthesia(17).
Dexmedetomidine, an alpha-2 adrenergic agonist, has gained significant attention for its sedative, analgesic, and anxiolytic properties in pediatric anesthesia(18).
Dexmedetomidine, a highly selective α 2- α 2-adrenergic agonist, has demonstrated sedative and analgesic properties without significant respiratory depression, making it particularly attractive in pediatric anesthesia. When used as an adjuvan to local anesthetics, dexmedetomidine prolongs block duration and reduces rescue analgesic requirements(17).
Despite the established role of caudal block and the emerging potential of sacral ESPB, there is a lack of randomized controlled trials directly comparing their analgesic efficacy in pediatric patients when combined with dexmedetomidine
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Quadruple blind (participant, care provider, investigator, outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Group A | Active comparator | Procedure: Caudal epidural blockCaudal Epidural Block |
| Group B | Active comparator | Procedure: Sacral ESP BlockSacral ESP Block |
Who may qualify
- Ages
- 1 year to 6 years
- Sex
- Male only
- Healthy volunteers
- Not accepted
- Age groups
- Child
Key inclusion criteria (1 listed)
- pediatric patients, aged 1-6 years, ASA physical statusI- II, scheduled for elective hypospadias repair surgery under general anesthesia.
Key exclusion criteria (6 listed)
- • Parental refusal.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Sacral ESP Block* Position: Prone with a pillow under the pelvis. * Ultrasound: High-frequency linear probe placed parasagittal, 1-1.5 cm lateral to the midline at S2-S3. Structure identified: skin → subcutaneous tissue → erector spinae muscle → sacral lamina. * Technique: An echogenic 22G needle will be advanced in-plane until contact with the sacral lamina under the erector spinae muscle. After hydro dissection with saline, the study drug will be injected with visible spread along the fascial plane. The same procedure will be repeated contralaterally. * Dose: Bupivacaine 0.25% total 1 mL/kg divided equally on both sides, dexmedetomidine 1 μ g/kg divided equally. | Procedure or surgery | Group B |
| Caudal epidural block* Position: Prone with a pillow under the pelvis. * Ultrasound: High-frequency linear probe placed parasagittal, 1-1.5 cm lateral to the midline at S2-S3. Structure identified: skin → subcutaneous tissue → erector spinae muscle → sacral lamina. * Technique: An echogenic 22G needle will be advanced in-plane until contact with the sacral lamina under the erector spinae muscle. After hydro dissection with saline, the study drug will be injected with visible spread along the fascial plane. The same procedure will be repeated contralaterally. * Dose: Bupivacaine 0.25% total 1 mL/kg divided equally on both sides, dexmedetomidine 1 μ g/kg divided equally. | Procedure or surgery | Group A |
Primary outcome
postoperative analgesia period
Time frame: 24 hours
duration of postoperative analgesia in studied patients
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 29 Sep 2025.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
The record lists no contact. Use the official record to reach the sponsor.
Questions about this trial
What is this clinical trial studying?
A Phase 3 study testing Sacral ESP Block and Caudal epidural block in people with Hypospadias, run by Assiut University.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 1 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: opening soon, as of the sponsor's last update on 29 Sep 2025. Status can change between updates, so confirm with the study contact before making plans.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
postoperative analgesia period (time frame: 24 hours). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 29 Sep 2025.