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Updated: Mar 8, 2026
An Experimental Paradigm for the Prediction of Post-Operative Pain PPOP
Published on: January 27, 2010
Comparison of preventive analgesia techniques in circumcision cases: Dorsal penile nerve block, caudal block, or
Ebru Canakci1, Ozgur Yagan1, Nilay Tas1
1Department of Anaesthesiology and Reanimation, Ordu University School of Medicine, Turkey.
Insights
The caudal block technique provided superior postoperative pain relief for pediatric circumcision compared to dorsal penile nerve block or subcutaneous morphine. This method minimized pain and stress for children and parents up to 12 hours post-surgery.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Surgical Procedures
Background:
- Effective postoperative pain management is crucial for pediatric surgical patients.
- Circumcision is a common procedure in male children requiring adequate analgesia.
- Comparing different preventive analgesia techniques can optimize patient outcomes.
Purpose of the Study:
- To compare the efficacy of caudal block, dorsal penile nerve block, and subcutaneous morphine for preventive analgesia in pediatric circumcision.
- To evaluate the duration and quality of postoperative analgesia provided by each technique.
- To assess the impact of these techniques on postoperative stress in children and parents.
Main Methods:
- Prospective, randomized, single-blind study involving 60 boys aged 6-12 years undergoing circumcision under general anesthesia.
- Patients were divided into three groups receiving caudal block (bupivacaine), subcutaneous morphine, or dorsal penile nerve block (bupivacaine).
- Pain and sedation scores were recorded at 1, 6, and 24 hours postoperatively using validated scales.
Main Results:
- The caudal block group (Group C) demonstrated significantly lower pain scores (<6) at 1 and 12 hours postoperatively compared to the morphine (Group M) and dorsal penile nerve block (Group DP) groups (p<0.05 and p<0.01, respectively).
- At 12 hours post-surgery, all patients in the caudal block group had pain scores <6, while 50% in the dorsal penile nerve block group and 25% in the morphine group had scores >6.
- No significant differences in sedation scores were observed among the three groups (p>0.05).
Conclusions:
- Caudal block with bupivacaine is an effective technique for providing prolonged postoperative analgesia up to 12 hours after pediatric circumcision.
- Preventive analgesia, particularly with caudal block, can significantly minimize postoperative stress for both children and their parents.
- The findings support the use of caudal block as a preferred method for pain management in pediatric circumcision.
Objective:
To compare 3 different techniques of preventive analgesia before circumcision operations in male children between 6-12 years of age. Our objective was to investigate the duration and quality of postoperative analgesia in patients, who were subject to caudal block technique, dorsal penile nerve block or who were administered subcutaneous morphine.
Methods:
The prospective, randomised, single-blind study was conducted at Ordu University Training and Research Hospital, Ordu, Turkey, from January 1 to June 30, 2015, and comprised boys aged 6-12 years, who were scheduled to undergo circumcision operation. All patients were under general anaesthesia by means of laryngeal masks. The patients were randomised into 3 equal groups. The patients in Group C received caudal block with bupivacaine 0.25% in a total volume of 0.50 ml/kg in lateral position. Those in Group M received injections of 100 mcg/kg of subcutaneous morphine into the deltoid muscle. Patients in Group DP were subjected to dorsal penile nerve block with 1 mg/kg of bupivacaine 0.25%. Intraoperative haemodynamic data, pain and sedation scores, according to Children's Hospital of Eastern Ontorio Pain Scale and Ramsay Sedation Scale, were recorded at postoperative 1st, 6th and 24th hours in all cases.
Results:
The 60 subjects in the study were divided into 3 groups of 20(33.3%) each. The overall mean age was 7.75±8.12 years. At 1 hour after surgery; 8(40%) cases in Group M, 5(25%) cases in Group DP, and all the 20(100%) cases in Group C had a pain score <6 (p<0.05). When the scores were analysed 12 hours post-operatively, 5(25%) cases in Group M and 10(50%) cases in Group DP had a pain score >6, while the pain scores of all the 20(100%) cases in Group C were <6 (p<0.01). Among the groups, there was no statistically significant difference regarding the sedation scores (p>0.05).
Conclusions:
Using the three methods, analgesia lasted until 12 hours postoperatively, being more evident in the caudal block group, minimising postoperative stress in children and parents.
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