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Background and Aims The pudendal nerve arises from the sacral plexus and innervates the urethral muscles, clitoris, penis, perineum, pelvic floor sphincter, urethra and bladder triangle. The pudendal nerve block may provide adequate perineal anesthesia during anorectal, urologic or obstetric procedures. We report a series of five pediatric patients who received a landmark based pudendal nerve block for intraoperative and postoperative analgesia following urethroplasty procedure.Methods All patients were male, aged 6–11 years old, who were scheduled to undergo penoscrotal urethroplasty. Written informed consent was obtained from all parents prior the procedure. All patients underwent general anesthesia with laryngeal mask airway. Following the induction, the patient was placed in dorsal lithotomy position or ‘frog leg position’. The perineal area was prepared and draped in typical sterile fashion. The index finger was utilized to palpate the ischial spine along the perineum. Then by using a 3.8 cm, 27-gauge needle was advanced approximately 1 cm inferior and medial to the attachment of the sacrospinous ligament to the ischial spine. An aspiration test was performed before local anesthetic injection to avoid any intravascular injection. After negative aspiration test, 0.25 ml/kgBW of plain Bupivacaine 0.25% was injected. The same procedure was then repeated contralaterally. Strict aseptic technique was followed throughout the procedure.Results In our case series of five pediatric patients undergoing urethroplasty, all patients received adequate pain control intraoperatively. During recovery period there was no agitation. Only two patients reported pain which required rescued analgesia for 24 hours postoperatively. Overall, parents were satisfied with the postoperative pain management.Abstract P100 Figure 1Landmark-approach pudendal nerve blockAbstract P100 Figure 2Schematic diagram of pudendal nerve blockConclusions Pudendal nerve block may serve as an alternative analgesia method, both for intraoperative and postoperative pain control, for pediatric patients. It provides an effective, safe and relatively cheap regional analgesia for patients undergoing urethroplasty procedure.