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[Postoperative analgesia for circumcision in children]
R Ramboatiana1, C Gassner, J P Schoch
1Département d'anesthésie-réanimation B. Centre hospitalier général André Boulloche-Montbéliard.
Insights
Pediatric circumcision causes significant pain. Combining regional anesthesia with general anesthesia, particularly dorsal penile nerve block, provides effective pain relief and may shorten hospital stays for children.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Pain Management
Context:
- Circumcision in children is frequently associated with severe postoperative pain.
- Ambulatory circumcision and short hospital stays are increasingly common.
- Effective pain management is crucial for pediatric surgical procedures.
Purpose:
- To retrospectively analyze and compare the effectiveness of different anesthetic techniques for pediatric circumcision.
- To evaluate postoperative pain control in children undergoing circumcision.
- To identify optimal anesthetic strategies for improving patient outcomes.
Summary:
- This study analyzed 110 children (17 months to 14 years) undergoing circumcision under regional anesthesia plus general anesthesia (53.6%) or general anesthesia alone (46.4%).
- Postoperative analgesia was superior in the regional anesthesia group, with dorsal penile nerve block (DNBP) being the most common regional technique (79.8%).
- Regional techniques, especially DNBP, demonstrated satisfactory, safe, and effective pain relief, with poor pain assessment in the general anesthesia-only group.
Impact:
- Regional anesthesia techniques, particularly DNBP, offer reliable and effective postoperative analgesia for pediatric circumcision.
- Systematic use of DNBP could enhance the safety and efficiency of day-case circumcision procedures.
- Improved pain management strategies can lead to better patient experiences and potentially shorter recovery times.
Abstract:
Circumcision in children is followed by severe pain. This study analysed retrospectively anesthetic techniques of 110 children from 17 months to 14 years old who had undergone ambulatory of 24 h stay circumcision. There were two groups of patients: one being operated on under locoregional techniques combined with general anesthesia (53.6%), the other one under general anesthesia alone (46.4%). Post operative analgesia was provided by the regional anesthesia (with or without additional analgesics via rectal route) for the former group whereas analgesic drugs were administered only rectally for the latter one. In this second group, pain relief assessment was insufficiently recorded and was considered poor. In the first group, dorsal nerves block of the penis (DNBP) was performed on 47 children (79.8% of the locoregional techniques), caudal block on 10 patients and ring block on 2 patients. Regional techniques offered a satisfactory, safe and reliably effective post circumcision analgesia. DNBP should be used systematically in order to shorten duration of day circumcision stay.