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Comparison of 3 regional anesthetic techniques for circumcision in obese children: A retrospective observational

Minyi Lin1, Jie Lin1, Xiang Gao1,2

  • 1Department of Anaesthesiology, Fujian Branch of Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Fujian Children's Hospital, Fuzhou, China.

Medicine
|October 7, 2025
PubMed

Insights

Ultrasound-guided dorsal penile nerve block (DPNB-US) offers superior pain management for pediatric circumcision in obese children compared to landmark-based blocks or caudal epidural anesthesia. DPNB-US reduces the need for rescue analgesia and intraoperative opioids, improving patient outcomes.

Area of Science:

  • Pediatric Surgery
  • Anesthesiology
  • Pain Management

Background:

  • Circumcision is a common pediatric surgery.
  • Effective pain management in obese children undergoing circumcision is challenging.
  • Limited comparative data exists for regional anesthesia efficacy in this population.

Purpose of the Study:

  • To evaluate and compare the efficacy of three regional anesthetic techniques for circumcision in obese pediatric patients.
  • To assess pain management effectiveness, opioid requirements, and parental satisfaction.

Main Methods:

  • Retrospective observational study of 235 obese children (≥6 years) undergoing circumcision.
  • Anesthesia groups: dorsal penile nerve block with ultrasound guidance (DPNB-US), dorsal penile nerve block with landmarks (DPNB-LM), and caudal epidural anesthesia (CEA).
  • Primary outcome: rescue analgesia within 6 hours postoperatively. Secondary outcomes: intraoperative opioid use, PACU sufentanil, complications, parental satisfaction.

Main Results:

  • Caudal epidural anesthesia (CEA) had the highest postoperative analgesia demand (91.8%), significantly more than DPNB-LM (12.5%) and DPNB-US (6.9%) (P<.001).
  • DPNB-US showed significantly lower intraoperative/PACU rescue opioid requirements compared to CEA and DPNB-LM.
  • Parental satisfaction was highest for DPNB-US (91.4%), followed by DPNB-LM (84.6%), and lowest for CEA (67.1%) (P<.001).

Conclusions:

  • Ultrasound-guided dorsal penile nerve block (DPNB-US) is superior to caudal epidural anesthesia (CEA) and landmark-based dorsal penile nerve block (DPNB-LM) for managing postoperative pain in obese pediatric circumcision patients.
  • DPNB-US significantly reduces the need for rescue analgesia and intraoperative opioid administration.
  • DPNB-US is a recommended alternative regional anesthesia technique for this vulnerable pediatric population.

Keywords:
CEADPNB-LMDPNB-UScircumcisionobese children

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