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A prmpective blind trial wus conducted comparing the analgesia and udrerse eflecrs produced h.y c~uudul extradural blockude (cuudul block) with blockade of' the dorsal nerves of the penis (penile hlmck) in 38 ho.ys undergoing elective circumcision. Analgesia was assessed by senior nurses using a linear unulopr .scale and by the response to direct questioning over the jirst 7 hours ufter .rurgerj. The degree und durution of' postoperative analgesia was similar in the fwo groups. However. the r~uudul hlock group iiud u higher incidence q f motor hlockude (p = < 0.01). One technical.failirre occurred in the penile block group. If is cmcluded that N penile block is a satisfactory alternative to ruudul hlwkatlr n.ith rrgurd t(1 postoperative unulgesia and q&s several spec@c advantages. There is a continuing search for a completely satisfactory method of pain relief after circum-cision. The basic requirements of any technique are that it is safe, reliably effective, and produces analgesia of adequate duration. In addition, further requirements can be suggested. including ease of administration. avoidance of the pain of injection, and a low risk of adverse effects, particularly those with serious and permanent sequelae. In the case of day-case surgery, rapid recovery is of importance. Caudal blockade with local anaesthetic solutions administered after induction of general anaesthesia prior to surgcry, has become a widespread approach to the problem. having been shown to be more efi-ective than intramuscular morphine.' However, although this has been shown to be a very safe technique, there is, nonetheless. a significant incidence of serious neurological sequelae.2 Batemanj advocates penile blockade as a simple and equally effective alternative. Bacon4 evaluated this technique in 20 patients, 17 of whom were children undergoing circum-cision. All cases experienced no pain for at least 6 hours postoperatively and no complications were noted during surgery, recovery. or at routine outpatient follow up. A blind prospective study was therefore planned to compare the techniques of penile and caudal blockade.

Nausea and vomiting are common complications of anaesthesia. Dexamethasone is an effective prophylaxis but is immunosuppressive and may increase postoperative infection risk. This retrospective cohort study examined the association between the administration of a single intraoperative anti-emetic dose of dexamethasone (4 to 8 mg) and postoperative infection in 439 patients undergoing single procedure, non-emergency surgery in a university trauma centre. Exclusion criteria included comorbidities, immunosuppressive medications or procedures that confer an increased infection risk. In the 10-week study period and three-month follow-up period, there were 98 documented infections (22.3% of the cohort), of which 43 were detected only on post-discharge follow-up. Anti-emetic dexamethasone was given to 108 patients (24.6%). Stepwise, multivariate logistic regression modelling identified significant associations between female gender, symptomatic reflux, respiratory disease and the risk of infection. The adjusted odds ratio for dexamethasone was 0.88 (0.5 to 1.5, P=0.656). We did not demonstrate an association between anti-emetic doses of dexamethasone and postoperative infection.

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