Comparison of postoperative analgesic effectiveness of caudal block, dorsal penile nerve block, and pudendal nerve block in children undergoing circumcision
Abstract
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
References
- American Academy of Pediatrics Task Force on Circumcision. Male circumcision. Pediatrics. 2012;130:756-85.
- Tree-Trakarn T, Pirayavaraporn S. Postoperative pain relief for circumcision in children: comparison among morphine, nerve block, and topical analgesia. Anesthesiology. 1985;62:519-22.
- Simpson JC, Bao X, Agarwala A. Pain management in enhanced recovery after surgery (eras) protocols. Clin Colon Rectal Surg. 2019;32:121-8.
- Munevveroglu C, Gunduz M. Postoperative pain management for circumcision; comparison of frequently used methods. Pak J Med Sci. 2020;36:91-5.
- Suresh S, Long J, Birmingham PK, De Oliveira GS Jr. Are caudal blocks for pain control safe in children? An analysis of 18,650 caudal blocks from the pediatric regional anesthesia network (pran) database. Anesth aAalg. 2015;120:151–6.
- Wang X, Dong C, Beekoo D, Qian X, Li J, Shang-Guan WN et al. Dorsal penile nerve block via perineal approach, an alternative to a caudal block for pediatric circumcision: A randomized controlled trial. Biomed Res Int. 2019;27:6875756.
- Naja ZM, Ziade FM, Kamel R, El-Kayali S, Daoud N, El-Rajab MA. The effectiveness of pudendal nerve block versus caudal block anesthesia for hypospadias in children. Anesth Analg. 2013;117:1401-7.
- Wiegele M, Marhofer P, Lönnqvist PA. Caudal epidural blocks in paediatric patients: a review and practical considerations. Br J Anaesth. 2019;122:509-17.
- Yucel S, Baskin LS. Neuroanatomy of the male urethra and perineum. BJU Int. 2003;92:624-30.
- Ozen V, Yigit D. A comparison of the postoperative analgesic effectiveness of low dose caudal epidural block and US-guided dorsal penile nerve block with in-plane technique in circumcision. J Pediatr Urol. 2020;16:99-106.
- 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.
- Aksu C, Akay MA, Şen MC, Gürkan Y. Ultrasound-guided dorsal penile nerve block vs neurostimulator-guided pudendal nerve block in children undergoing hypospadias surgery: A prospective, randomized, double-blinded trial. Paediatr Anaesth. 2019;29:1046-52.
- Kazak Bengisun Z, Ekmekci P, Haliloğlu AH. Levobupivacaine for postoperative pain management in circumcision: caudal blocks or dorsal penile nerve block. Agri. 2012;24:180-6.
- Long RM, McCartan D, Cullen I, Harmon D, Flood HD. A preliminary study of the sensory distribution of the penile dorsal and ventral nerves: implications for effective penile block for circumcision. BJU Int. 2010;105:1576-8.
- Moore KL. Clinically Oriented Anatomy, 3rd edn. Baltimore, Harwal Publishing Co, 1992.
- Canakci E, Yagan O, Tas N, Mutlu T, Cirakoglu A, Benli E. Comparison of preventive analgesia techniques in circumcision cases: Dorsal penile nerve block, caudal block, or subcutaneous morphine? J Pak Med Assoc. 2017;67:159-65.
- Haliloglu AH, Gokce MI, Tangal S, Boga MS, Tapar H, Aladag E. Comparison of postoperative analgesic efficacy of penile block, caudal block and intravenous paracetamol for circumcision: a prospective randomized study. Int Braz J Urol. 2013;39:551-7.
- Tutuncu AC, Kendigelen P, Ashyyeralyeva G, Altintas F, Emre S, Ozcan R et al. Pudendal nerve block versus penile nerve block in children undergoing circumcision. Urol J. 20183;15:109-15.
- 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.
- Hecht S, Piñeda J, Bayne A. Ultrasound-guided pudendal block ıs a viable alternative to caudal block for hypospadias surgery: a single-surgeon pilot study. Urology. 2018;113:192-6.
- Okoro C, Huang H, Cannon S, Low D, Liston DE, Richards MJ et al. The pudendal nerve block for ambulatory urology: What's old is new again. A quality improvement project. J Pediatr Urol. 2020;16:594.e1-594.e7.
- Dobereiner EF, Cox RG, Ewen A, Lardner DR. Evidence-based clinical update: which local anesthetic drug for pediatric caudal block provides optimal efficacy with the fewest side effects? Can J Anaesth. 2010;57:1102–10.
- Ecoffey C, Lacroix F, Giaufré E, Orliaguet G, Courrèges P. Epidemiology and morbidity of regional anesthesia in children: a follow-up one-year prospective survey of the French-language society of paediatric anaesthesiologists (ADARPEF). Paediatr Anaesth. 2010;20:1061–69.
- Shafik AA, Shafik IA, El Sibai O. On the etiology of the electric activity of the external anal and urethral sphincters. J Invest Surg. 2014;27:267-72.
- Garrido-Abad P, Suárez-Fonseca C. Glans ischemia after circumcision and dorsal penile nerve block: Case report and review of the literature. Urol Ann. 2015;7:541-3.
Sünnet cerrahisinde kaudal blok, dorsal penil sinir bloğu ve pudendal sinir bloğunun postoperatif analjezik etkinliğinin karşılaştırılması
Abstract
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.
References
- American Academy of Pediatrics Task Force on Circumcision. Male circumcision. Pediatrics. 2012;130:756-85.
- Tree-Trakarn T, Pirayavaraporn S. Postoperative pain relief for circumcision in children: comparison among morphine, nerve block, and topical analgesia. Anesthesiology. 1985;62:519-22.
- Simpson JC, Bao X, Agarwala A. Pain management in enhanced recovery after surgery (eras) protocols. Clin Colon Rectal Surg. 2019;32:121-8.
- Munevveroglu C, Gunduz M. Postoperative pain management for circumcision; comparison of frequently used methods. Pak J Med Sci. 2020;36:91-5.
- Suresh S, Long J, Birmingham PK, De Oliveira GS Jr. Are caudal blocks for pain control safe in children? An analysis of 18,650 caudal blocks from the pediatric regional anesthesia network (pran) database. Anesth aAalg. 2015;120:151–6.
- Wang X, Dong C, Beekoo D, Qian X, Li J, Shang-Guan WN et al. Dorsal penile nerve block via perineal approach, an alternative to a caudal block for pediatric circumcision: A randomized controlled trial. Biomed Res Int. 2019;27:6875756.
- Naja ZM, Ziade FM, Kamel R, El-Kayali S, Daoud N, El-Rajab MA. The effectiveness of pudendal nerve block versus caudal block anesthesia for hypospadias in children. Anesth Analg. 2013;117:1401-7.
- Wiegele M, Marhofer P, Lönnqvist PA. Caudal epidural blocks in paediatric patients: a review and practical considerations. Br J Anaesth. 2019;122:509-17.
- Yucel S, Baskin LS. Neuroanatomy of the male urethra and perineum. BJU Int. 2003;92:624-30.
- Ozen V, Yigit D. A comparison of the postoperative analgesic effectiveness of low dose caudal epidural block and US-guided dorsal penile nerve block with in-plane technique in circumcision. J Pediatr Urol. 2020;16:99-106.
- 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.
- Aksu C, Akay MA, Şen MC, Gürkan Y. Ultrasound-guided dorsal penile nerve block vs neurostimulator-guided pudendal nerve block in children undergoing hypospadias surgery: A prospective, randomized, double-blinded trial. Paediatr Anaesth. 2019;29:1046-52.
- Kazak Bengisun Z, Ekmekci P, Haliloğlu AH. Levobupivacaine for postoperative pain management in circumcision: caudal blocks or dorsal penile nerve block. Agri. 2012;24:180-6.
- Long RM, McCartan D, Cullen I, Harmon D, Flood HD. A preliminary study of the sensory distribution of the penile dorsal and ventral nerves: implications for effective penile block for circumcision. BJU Int. 2010;105:1576-8.
- Moore KL. Clinically Oriented Anatomy, 3rd edn. Baltimore, Harwal Publishing Co, 1992.
- Canakci E, Yagan O, Tas N, Mutlu T, Cirakoglu A, Benli E. Comparison of preventive analgesia techniques in circumcision cases: Dorsal penile nerve block, caudal block, or subcutaneous morphine? J Pak Med Assoc. 2017;67:159-65.
- Haliloglu AH, Gokce MI, Tangal S, Boga MS, Tapar H, Aladag E. Comparison of postoperative analgesic efficacy of penile block, caudal block and intravenous paracetamol for circumcision: a prospective randomized study. Int Braz J Urol. 2013;39:551-7.
- Tutuncu AC, Kendigelen P, Ashyyeralyeva G, Altintas F, Emre S, Ozcan R et al. Pudendal nerve block versus penile nerve block in children undergoing circumcision. Urol J. 20183;15:109-15.
- 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.
- Hecht S, Piñeda J, Bayne A. Ultrasound-guided pudendal block ıs a viable alternative to caudal block for hypospadias surgery: a single-surgeon pilot study. Urology. 2018;113:192-6.
- Okoro C, Huang H, Cannon S, Low D, Liston DE, Richards MJ et al. The pudendal nerve block for ambulatory urology: What's old is new again. A quality improvement project. J Pediatr Urol. 2020;16:594.e1-594.e7.
- Dobereiner EF, Cox RG, Ewen A, Lardner DR. Evidence-based clinical update: which local anesthetic drug for pediatric caudal block provides optimal efficacy with the fewest side effects? Can J Anaesth. 2010;57:1102–10.
- Ecoffey C, Lacroix F, Giaufré E, Orliaguet G, Courrèges P. Epidemiology and morbidity of regional anesthesia in children: a follow-up one-year prospective survey of the French-language society of paediatric anaesthesiologists (ADARPEF). Paediatr Anaesth. 2010;20:1061–69.
- Shafik AA, Shafik IA, El Sibai O. On the etiology of the electric activity of the external anal and urethral sphincters. J Invest Surg. 2014;27:267-72.
- Garrido-Abad P, Suárez-Fonseca C. Glans ischemia after circumcision and dorsal penile nerve block: Case report and review of the literature. Urol Ann. 2015;7:541-3.
Details
| Primary Language | English |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Research |
| Authors | |
| Publication Date | March 31, 2022 |
| Acceptance Date | January 19, 2022 |
| Published in Issue | Year 2022 Volume: 47 Issue: 1 |
