Sacral erector spinae plane block for hypospadias surgery in a patient with Denys-Drash Syndrome: a case report

Abstract

Hypospadias is a common congenital anomaly requiring surgical correction. Postoperative analgesia is challenging in patients with congenital syndromes affecting drug metabolism. Denys-Drash syndrome (DDS) is a rare disorder characterized by nephrotic syndrome and end-stage renal disease, limiting nonsteroidal anti-inflammatory drug (NSAID) and opioid use. We report a 2-year, 7-month-old boy with DDS undergoing hypospadias repair. A sacral erector spinae plane block (ESPB) provided effective analgesia, requiring only paracetamol postoperatively. This case highlights sacral ESPB as a safe, opioid-sparing alternative for pediatric urogenital surgery, especially in patients with nephrological impairments.