A comparison of three methods of analgesia in children having day case circumcision

Area of Science:

• Pediatric Surgery
• Pain Management
• Anesthesiology

Background:

• Circumcision is a common pediatric surgical procedure.
• Effective pain management is crucial for optimizing patient outcomes and parental satisfaction following circumcision.
• Various analgesia methods are employed, but optimal strategies require further investigation.

Purpose of the Study:

• To compare the efficacy of different analgesia methods for day case circumcision in children.
• To evaluate pain scores and parental-reported outcomes following three distinct pain management protocols.

Main Methods:

• Sixty-one children undergoing day case circumcision were randomized into three groups.
• Group 1: Penile block. Group 2: Penile block plus diclofenac suppository. Group 3: Diclofenac suppository alone.
• Pain was assessed using the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) at multiple time points, with parental follow-up for two days.

Main Results:

• No significant differences in pain scores or outcomes were observed between groups at one and two hours post-awakening, or in parental follow-up.
• However, in the recovery area, Group 3 (diclofenac suppository alone) exhibited higher pain scores and more crying compared to Group 2 (penile block plus diclofenac).

Conclusions:

• A penile block combined with a diclofenac suppository appears to be more effective in immediate post-operative pain control than a diclofenac suppository alone for pediatric circumcision.
• While overall pain scores and parental satisfaction were similar across groups over two days, the combination approach offers superior acute pain relief in the recovery setting.