Topical and systemic analgesia versus caudal epidural and dorsal penile nerve block in relieving pain after pediatric circumcision

Abstract

Objective: There is no consensus on the use of optimal analgesic method after pediatric circumcision, although, caudal block (CB),dorsal penile nerve block (DPNB), topical local anesthetic application and systemic analgesic administration are frequently usedmethods. In this study, we aimed to compare the postoperative analgesic effects and side effects, as well as parental satisfactionconcerning these methods.Patients and Methods: Eighty children, aged 3-12 years, undergoing circumcision were randomized into four groups (n=20). GroupCaudal Anesthesia (CA), Group Dorsal Penile Blok (DP), Group Topical Analgesia (TA), Group Systemic Analgesics (SA). Theseverity of pain was measured with NRS or CHEOPS scores. Time to awakening, first analgesic requirement, hospital discharge, sideeffects and parental satisfaction were recorded.Results: In groups CA and DP, pain scores during the first postoperative hour were lower than the pain scores of other groups and ingroup CA, the first analgesic requirement time was significantly longer compared to other groups (p<0.05). In the early postoperativehour, parental satisfaction was higher in group CA compared to other groups.Conclusion: In the early postoperative period, CB and DPNB reduce pain more effectively and provide more parental satisfactionthan other applications, (in children who underwent) circumcision.Keywords: Circumcision, Pain, Postoperative, Dorsal penile nerve block Caudal epidural block, EMLA