Sünnet cerrahisinde kaudal blok, dorsal penil sinir bloğu ve pudendal sinir bloğunun postoperatif analjezik etkinliğinin karşılaştırılması

Amaç: Bu çalışmada, sünnet cerrahisi geçiren çocuklarda kaudal blok, dorsal penil sinir bloğu (DPNB) ve pudendal sinir bloğunun (PNB) postoperatif analjezik etkinliğinin karşılaştırılması amaçlandı. Gereç ve Yöntem: Bu retrospektif çalışmada 18 aylık süreçte sünnet cerrahisi olan hastaların kayıtları incelendi. Hastaların demografik bilgileri, intraoperatif hemodinamik parametreleri, sinir bloğu uygulama süresi, kurtarma analjezik süresi, anestezi ve cerrahi süresi, derlenme süresi ve postoperatif komplikasyonlar kaydedildi. Poastoperatif ağrı, Face, Legs, Activity, Cry, Consolability (FLACC) ağrı skalası kullanılarak değerlendirildi. Bulgular: Çalışmaya yaşları 2-12 arasında değişen toplam 216 erkek hasta dahil edildi. Hastalara DPNB (n= 78), kaudal blok (n= 72) ve PNB (n= 66) uygulandı. FLACC ağrı skorları DPNB grubunda anlamlı olarak daha yüksekti. Tamamı DPNB grubunda olan 49 hastada ek analjeziklere ihtiyaç duyuldu. Postoperatif komplikasyonlar DPNB ve PNB'ye kıyasla kaudal bloğu olanlarda daha sık gözlendi. Sonuç: Sünnet uygulanan çocuklarda postoperatif ağrı yönetiminde kaudal ve pudendal sinir bloğunun DPNB'ye göre daha etkin olduğu görülmüştür. Uygulanacak bloğun seçiminde anestezistin deneyimi ve yan etkiler dikkate alınmalıdır.

Anahtar Kelimeler:

Kaudal blok, sünnet, dorsal penil sinir bloğu, ameliyat sonrası analjezi, pudendal sinir bloğu

Comparison of postoperative analgesic effectiveness of caudal block, dorsal penile nerve block, and pudendal nerve block in children undergoing circumcision

Purpose: This study aimed at comparing the postoperative analgesic effectiveness of three types of nerve blocks (caudal block, dorsal penile nerve block (DPNB), and pudendal nerve block (PNB) in children undergoing circumcision. Materials and Methods: In this retrospective study, patient records of those who underwent circumcision during an 18-month period were included in this study. Data collected included demographics, intraoperative hemodynamic parameters, nerve block application time, rescue analgesic time, duration of anesthesia and surgery, recovery time, and postoperative complications. Postoperative pain was evaluated using the Face, Legs, Activity, Cry, Consolability (FLACC) pain scale. Results: A total of 216 male patients, aged 2-12 years, were included in this study. The majority received DPNB (n= 78), followed by caudal block (n= 72) and PNB (n= 66). The FLACC pain scores were significantly higher in the DPNB group. Rescue analgesics were required by 49 patients, all of whom were in the DPNB group. Postoperative complications were more frequently observed among those with the caudal block, compared to DPNB and PNB. Conclusion: Caudal and pudendal nerve block had the highest effectiveness in terms of postoperative analgesia in patients undergoing circumcision. The decision of choosing between them should take into account the experience of the practitioner, as well as side effects.

Keywords:

Caudal block, circumcision, dorsal penile nerve block, postoperative analgesia, pudendal nerve block,

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