A Comparison of the Postoperative Analgesic Effectiveness of Ultrasound-Guided Dorsal Penile Nerve Block and Ultrasound-Guided Pudendal Nerve Block in Circumcision

Abstract

The aim of this study was to compare the postoperative analgesic effectiveness of the 2 block types. We also aimed to evaluate the effect of these block types on the postoperative complications and parental satisfaction. Materials and Methods: This prospective observational study was conducted between April and July 2019 at a training and research hospital. Patients aged between 5 and 12 years in the ASA I-II group, who were scheduled for circumcision, were included in the study. The primary outcome was the pain measured using the Children's Hospital Eastern Ontario Pain Scale and the Faces Pain Scale-Revised. The secondary outcomes were the postoperative complications and parenteral satisfactions. Results: The number of patients receiving a pudendal block (n = 40) and dorsal penile nerve block (DPNB) block (n = 40) was equal. No statistically significant difference was found between the groups that were administered a DPNB and pudendal block in terms of pain scores (p > 0.05). We did not observe any postoperative block-related complications or side effects. Parents reported excellent satisfaction in both groups. Discussion: Ultrasound (US)-guided pudendal nerve block and US-guided DPNB provided effective and long-lasting postoperative analgesia for circumcision surgery. Conclusions: This study has shown that both blocks provide postoperative analgesia with similar effectiveness and ensured a very comfortable period at the circumcision surgery. Clinicians can use either of these techniques depending on their clinical circumstances and experience.

Randomized controlled trial (RCT) comparing ultrasound-guided pudendal nerve block with ultrasound-guided penile nerve block for analgesia during pediatric circumcision

“…However, none of these studies used ultrasound guidance 10 11. A recent observational study using ultrasound for both blocks did find similar results to ours 12. Our study is the first blinded randomized study comparing both ultrasound-guided blocks.…”

“…In the past, two randomized controlled trials (RCTs) comparing PNB and DPNB without ultrasound use for penile surgeries, showed lower pain scores and lower narcotics consumption with the PNB 10 11. One other recent observational study compared UG-PNB and UG-DPNB and showed similar effectiveness 12. However, there is no blinded randomized study comparing PNB and DPNB when both are performed using ultrasound guidance.…”

Ultrasound-Guided Pudendal Nerve Block versus Ultrasound-Guided Dorsal Penile Nerve Block for Pediatric Distal Hypospadias Surgery

“…The ischiorectal fossa is a narrow and a fatty area and facilitates the diffusion of the administered local anesthetic into the pudendal nerve. Therefore, it is recommended to insert the block needle properly into the ischiorectal fossa under US guidance for a successful PNB [10, 18].…”

“…The remaining solution was then injected into the other side of the hip. The patient was now again placed in the supine position [10] (shown in Fig. 1c).…”

“…The regional anesthesia techniques used for postoperative analgesia in hypospadias repair include the peripheral nerve blocks of pudendal nerve block (PNB) and dorsal penile nerve block (DPNB) [4, 7]. Ultrasound (US) has recently become increasingly popular in regional anesthesia practice and is used to aid these two peripheral nerve block applications in various pediatric urological procedures [2, 10]. US-guided DPNB has been shown to provide effective and long-term analgesia when compared to CEB in a recent study on hypospadias surgery in the pediatric population [2].…”