A retrospective audit of three different regional anaesthetic techniques for circumcision in children

Area of Science:

• Anesthesiology
• Pediatric Surgery
• Pain Management

Background:

• Traditional postoperative analgesia for male circumcision includes landmark-based dorsal penile nerve block (DPNB-LM) and caudal epidural analgesia (CEA).
• The effectiveness and safety of these methods, alongside ultrasound-guided dorsal penile nerve block (DPNB-US), require comparative analysis.

Purpose of the Study:

• To retrospectively analyze and compare the effectiveness and safety of CEA, DPNB-LM, and DPNB-US for male circumcision surgery.
• To evaluate postoperative pain management outcomes, including rescue medication requirements and recovery times.

Main Methods:

• Retrospective analysis of medical records for 216 male circumcisions performed over six years.
• Patients were categorized into three groups: CEA (n=115), DPNB-LM (n=46), and DPNB-US (n=55).
• Data collected included rescue morphine administration, total morphine dose, recovery ward stay, time to first analgesia, intraoperative opiate use, and time to hospital discharge.

Main Results:

• The DPNB-LM group required significantly more rescue morphine (30.4%) and intraoperative opiates (63%) compared to DPNB-US (3.5%, 5.5%) and CEA (3.6%, 1.7%).
• DPNB-LM also resulted in longer recovery ward stays.
• Time to first analgesia was longest with CEA, with no significant difference between DPNB-LM and DPNB-US. Hospital discharge times were similar across all groups.

Conclusions:

• Ultrasound-guided DPNB and CEA provide superior postoperative analgesia for pediatric male circumcision compared to landmark-based DPNB.
• DPNB-US offers a safer and more effective alternative to DPNB-LM, reducing opioid requirements and recovery time.
• Both DPNB-US and CEA are effective strategies for managing pain after circumcision, with DPNB-US showing comparable efficacy to CEA in reducing opioid needs.