Comparison of postoperative analgesic efficacy of caudal block versus dorsal penile nerve block with bupivacaine for circumcision in children

Abstract

Background: Circumcision is a frequently performed surgery in pediatric patient. Objective: Our aim is to compare postoperative analgesia of caudal block versus dorsal penile nerve block (DPNB) and to compare sedation score and complication associated with caudal block and DPNB in children undergoing circumcision. Materials and Methods: This prospective randomized study was performed for more than 50 patients of ASA grade I, aged 3-12 years, scheduled for elective circumcision. Patients were divided into two groups: DPNB for group I and caudal block for group II, using 0.25% 1 mL/kg (2 mg/kg) bupivacaine. Postoperative analgesia was evaluated for 6 hours with the FLACC Pain Scale for five categories: (F) face, (L) legs, (A) activity, (C) cry, and (C) consolability. Sedation was evaluated with Ramsey sedation score. For every child, supplementary analgesic amount and times and probable local or systemic complications were recorded. Results: No significant difference between both the groups was found in mean age, body weight, and surgery duration and sedation scores. Initially, for 2 hours, FLACC pain score was also insignificant; however, on subsequent measurements, a significant difference of FLACC pain score was noted in both the groups. No major complication was found when using either technique. Conclusion: Duration of postoperative analgesia is more in caudal group than that of DPNB. Supplementary analgesic need is also minimized.

Low-dose caudal versus dorsal penile nerve block for postoperative analgesia after circumcision: a randomized comparative study

“…Only minor bleeding occurred with one patient after penile block was done, and it responded to compression without occurrence of significant haematoma. The same findings were also observed by Patel et al [19].…”

“…Patel et al [19] showed that the pain scores were not significantly different between the caudal and dorsal penile block groups initially for the first 2 hours postoperatively, but on subsequent recordings a significant difference of pain scores was noted between the 2 groups, being significantly lower in the caudal group and the time to first analgesic requirement was significantly shorter in the DPNB group in comparison to the CNB group. These results agree with our study confirming the superiority of CNB to DPNB regarding postoperative pain control.…”

Our Experiences of Pre-emptive Analgesia in Pediatric Penile Surgery: A Retrospective Comparison of the Analgesic Effects of Caudal Block and Dorsal Penile Block

“…However, there are contrasting opinions. Patel et al identified the period of postoperative analgesia with bupivacaine as 204 min in the caudal group and 120 min in the penile group 18 . The duration of postoperative analgesia was determined to be statistically significantly longer in the caudal group.…”