Topical and systemic analgesia versus caudal epidural and dorsal penile nerve block in relieving pain after pediatric circumcision
Objective: There is no consensus on the use of optimal analgesic method after pediatric circumcision, although, caudal block (CB),dorsal penile nerve block (DPNB), topical local anesthetic application and systemic analgesic administration are frequently usedmethods. In this study, we aimed to compare the postoperative analgesic effects and side effects, as well as parental satisfactionconcerning these methods.Patients and Methods: Eighty children, aged 3-12 years, undergoing circumcision were randomized into four groups (n=20). GroupCaudal Anesthesia (CA), Group Dorsal Penile Blok (DP), Group Topical Analgesia (TA), Group Systemic Analgesics (SA). Theseverity of pain was measured with NRS or CHEOPS scores. Time to awakening, first analgesic requirement, hospital discharge, sideeffects and parental satisfaction were recorded.Results: In groups CA and DP, pain scores during the first postoperative hour were lower than the pain scores of other groups and ingroup CA, the first analgesic requirement time was significantly longer compared to other groups (p<0.05). In the early postoperativehour, parental satisfaction was higher in group CA compared to other groups.Conclusion: In the early postoperative period, CB and DPNB reduce pain more effectively and provide more parental satisfactionthan other applications, (in children who underwent) circumcision.Keywords: Circumcision, Pain, Postoperative, Dorsal penile nerve block Caudal epidural block, EMLA
___
- [1] Lonnqvist PA, Morton NS. Paediatric day-case anaesthesia
and pain control. Curr Opin Anaesthesiol 2006; 19:617-21.
doi: 10.1097/ACO.0b013e3280101dab.
- [2] Howard R, Carter B, Curry J, et al. Postoperative pain.
Paediatr Anaesth 2008; 18:36-63. doi: 10.1111/j.1460-
9592.2008.02431.x.
- [3] Paix BR, Peterson SE. Circumcision of neonates and
children without appropriate anaesthesia is unacceptable
practice. Anaesth Intensive Care 2012; 40:511-6. doi:
10.1177/0310057X120.400.0318.
- [4] Cyna AM, Middleton P. Caudal epidural block versus other
methods of postoperative pain relief for circumcision in boys.
Cochrane Database of Syst Rev 2008;4: Art No:CD003005.
doi: 10.1002/14651858.CD003005.pub2
- [5] Naja Z, Al-Tannir MA, Faysal W, Daoud N, Ziade F, El-Rajab
M. A comparison of pudendal block vs dorsal penile nerve
block for circumcision in children: a randomised controlled
trial. Anaesthesia 2011; 66:802-7. doi: 10.1111/j.1365-
2044.2011.06753.x
- [6] Taddio A, Ohlsson A, Einarson TR, Stevens B, Koren G. A
systematic review of lidocaine-prilocaine cream (EMLA)
in the treatment of acute pain in neonates. Pediatrics 1998;
101:1-9. doi: 10.1542/peds.101.2.e1
- [7] Linder SL, Winner P. Pediatric headache. Med Clin North Am.
2001;85:1037-53. doi:10.1016/s0025-7125(05)70358-8
- [8] McGowan PR, May H, Molnar Z, Cunliffe M. A comparison
of three methods of analgesia in children having day
case circumcision. Paediatr Anaesth 1998; 8: 403-7. doi:
10.1046/j.1460-9592.1998.00270.x
- [9] Lönnqvist PA, Morton NS. Postoperative analgesia in infants
and children. Br J Anaesth 2005; 95:59-68. doi: 10.1093/bja/
aei065
- [10] Jöhr M, Berger TM. Caudal blocks. Paediatr Anaesth 2012;
22:44-50. doi: 10.1111/j.1460-9592.2011.03669.x.
- [11] Weksler N, Atias I, Klein M, Rosenztsveig V, Ovadia L,
Gurman GM. Is penile block better than caudal epidural block
for postcircumcision analgesia? J Anesth 2005; 19:36-9. doi:
10.1007/s00540.004.0287-8.
- [12] Munevveroglu C, Gunduz M. Postoperative pain management
for circumcision; Comparison of frequently used methods. Pak
J Med Sci 2020;36:91-95. doi:10.12669/pjms.36.2.505
- [13] Wolf AR, Valley RD, Fear DW, Roy WL, Lerman J. Bupivacaine
for caudal analgesia in infants and children: the optimal
effective concentration. Anesthesiology 1988; 69: 102-6. doi:
10.1097/00000.542.198807000-00017.
- [14] Tree-Trakarn T, Pirayavaraporn S. Post-operative pain relief
for circumcision in children: comparison among morphine,
nerve block and topical analgesia. Anesthesiology 1985;
62:519-22. doi: 10.1097/00000.542.198504000-00027.
- [15] Beyaz SG. Comparison of postoperative analgesic efficacy
of caudal block versus dorsal penile nerve block with
levobupivacaine for circumcision in children. Korean J Pain
2011; 24:31-5. doi: 10.3344/kjp.2011.24.1.31.
- [16] Sara CA, Lowry CJ. A complication of circumcision and dorsal
nerve block of the penis. Anaesth Intensive Care. 1985; 13:79-
85. doi: 10.1177/0310057X850.130.0111.
- [17] Burke D, Joypaul V, Thomson MF. Circumcision supplemented
by dorsal penile nerve block with 0.75% ropivacaine: a
complication. Reg Anesth Pain Med 2000; 25:424-27. doi:
10.1053/rapm.2000.7594.
- [18] Margetts L, Carr A, McFadyen G, Lambert A. A comparison
of caudal bupivacaine and ketamine with penile block for
paediatric circumcision. Eur J Anaesthesiol 2008; 25: 1009-13.
doi: 10.1017/S026.502.1508004833.
- [19] Choi WY, Irwin MG, Hui TWC, Lim HH, Chan KL. EMLA
cream versus dorsal penile nerve block for postcircumcision
analgesia in children. Anesth Analg 2003; 96: 396-99. doi:
10.1097/00000.539.200302000-00018.