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Circumcision in children with penile block alone
1Division of Pediatric Surgery, E. Wolfson Medical Center, Holon, Israel.
Insights
Dorsal penile nerve block alone offers effective intraoperative analgesia for pediatric circumcision, especially in children over six years old. This technique reduces postoperative complications compared to general anesthesia.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Pain Management
Background:
- Pediatric surgical procedures, including circumcision, typically involve general anesthesia.
- Dorsal penile nerve block is commonly used for postoperative pain relief after circumcision.
- This study investigates the efficacy of dorsal penile nerve block as the sole anesthetic for intraoperative pain management in pediatric circumcision.
Purpose of the Study:
- To evaluate the effectiveness of dorsal penile nerve block as a standalone anesthetic for intraoperative pain relief during pediatric circumcision.
- To compare the outcomes of using dorsal penile nerve block alone versus general anesthesia with additional nerve block.
Main Methods:
- Retrospective evaluation of 454 children aged 3-11 years undergoing circumcision.
- Dorsal penile nerve block administered as the sole anesthetic for intraoperative analgesia.
- Data collected on analgesia quality, complications, operating time, and recovery.
Main Results:
- Dorsal penile nerve block alone provided good intraoperative analgesia in most cases (97.1% success rate).
- Minor complications included hematoma (2.6%) and mild edema (18.3%).
- Failure rate was higher in younger children (3-5 years old) compared to older children (>6 years old).
Conclusions:
- Dorsal penile nerve block alone is a safe and effective anesthetic for pediatric circumcision, particularly for children over six years of age.
- This approach is associated with shorter recovery times and fewer postoperative adverse effects like nausea and vomiting compared to general anesthesia.
- The technique shows promise in reducing the need for general anesthesia in this pediatric surgical population.
Abstract:
Surgical procedures in children are usually performed with the patient under general anesthesia. For circumcision and additional dorsal penile nerve block is used for postoperative analgesia. We retrospectively evaluated dorsal penile nerve block as the only analgesic technique for the relief of intraoperative pain in children undergoing circumcision. For 6 months dorsal penile nerve block was performed in 454 children 3 to 11 years old (mean 8.15 +/- 2.08 years) as the sole preoperative anesthesia. All boys were considered to have had good preoperative analgesia. No major complications were reported. Block related hematoma was noted in 12 patients (2.6%) and mild local edema occurred in 83 (18.3%). There was no excessive bleeding and hemostasis was easily achieved. The overall average operating time was 7.2 +/- 2.6 minutes (range 6 to 25). General anesthesia was added in 13 patients, representing a dorsal penile nerve block failure rate of 2.9%. Four boys suffered from erratic pain, while no objective cause of failure was recorded in the remaining 9. Average patient age was 5.8 +/- 2.2 years (range 3 to 10) in the 13 boys and 8.2 +/- 2 years (range 3 to 11) in the remaining 441 patients (p < 0.001). Failure was more frequent in children 3 to 5 years old (15.5%) than in those older than 6 years (1.5%, p < 0.05). Average operating time was 20.7 +/- 2.8 minutes (range 15 to 25) in the 13 children and 6.8 +/- 1.1 minutes (range 6 to 15) in the remaining 441 (p < 0.001). During the recovery period, only children from the general anesthesia group suffered from nausea and vomiting (9), and pain, agitation and fear (6 boys 3 to 6 years old). Average recovery room time was 38.7 +/- 7.4 minutes (range 30 to 60) in children with dorsal penile nerve block alone and 95 +/- 9.8 minutes (range 85 to 120) in those with additional general anesthesia (p < 0.001). We conclude that dorsal penile nerve block alone provides good intraoperative analgesia for circumcision in children, particularly those older than 6 years.