A comparison of caudal bupivacaine and ketamine with penile block for paediatric circumcision

Abstract

To establish whether caudal with ketamine or penile block provide superior postoperative analgesia for paediatric circumcision. This was a single centre, prospective, randomized, controlled, double-blind trial. Forty males (aged between 18 months and 16 yr) were randomized to receive either a penile block using 0.25 mL kg(-1) 0.5% bupivacaine (Group P), or a caudal block using 0.5 mL kg(-1) 0.25% bupivacaine with 0.5 mg kg(-1) ketamine (Group C). All of them were given a standard anaesthetic and rectal paracetamol 40 mg kg(-1) and diclofenac 1-1.5 mg kg(-1). Postoperative pain scores were assessed in recovery and the time to first analgesia, micturition and walking were recorded. There were no failures in either group. The time to first analgesia was longer in Group C (C median = 459 min, interquartile range 374-553 min; P median = 374 min, interquartile range 224-507 min; P < 0.05). There was a delay in time to walking in Group C (C median = 162 min, interquartile range 119-208 min; P median = 120 min, interquartile range 92-132 min; P < 0.05). There was no difference between the groups in time to waking or micturition, or the incidence of vomiting, abnormal behaviour or bleeding. Caudal bupivacaine with ketamine and penile block both provide effective postoperative analgesia for circumcision when given with non-steroidal anti-inflammatory drugs. This study shows that caudal bupivacaine with ketamine provides a longer duration of analgesia than penile block, but also causes delay in walking.