Ultrasound-guided penile block for circumcision instead of anatomical landmark method in newborn babies

Background The primary objective of this study is to compare the effectiveness of the newborn’s penile block performed by the surgeon using the classical landmark method and the penile block performed by the anesthesiologist with ultrasound guidance. Results This prospective, single-blinded, randomized clinical study included a total of forty newborn babies scheduled to undergo elective circumcision. The babies were randomized into two treatment groups of ultrasound (US)-guided penile block (group I; n = 20) and classical landmark method dorsal penile nerve block (DPNB) (group II; n = 20) group. Face, Legs, Activity, Cry, Consolability (FLACC) score was used to determine the block efficacy and postoperative pain and analgesic requirements. Intraoperative and postoperative FLACC scores, intraoperative analgesic needs, discharge time, complications, first oral intake time, and parent’s satisfaction were also recorded. FLACC scores were higher in group II than in group I during the intraoperative periods. Heart rate was higher in group II than in group I, at the incision, and during the procedure (P < 0.05). The number of patients requiring fentanyl was higher in group II than in group I (P < 0.01). FLACC scores were statistically higher in the landmark group at arrival in the PACU (P < 0.01) and after 30 min up to 2 h (P < 0.01). Parent’s satisfaction was significantly higher in US group (P < 0.01) Conclusions Intraoperative analgesic needs and pain scores are lower in newborn babies who performed penile block with ultrasound-guided compared to the landmark method.

Caudal block versus penile block for postoperative analgesia in children undergoing hypospadias repair

Background Hypospadias repair is one of the most frequently performed surgical procedures in the pediatric population. Using optimal analgesic regimen provides safe and effective analgesia, reduce postoperative stress response and accelerate recovery from surgery. Aim of the Work The aim of this work is to evaluate the success rate and the effectiveness of penile block for hypospadias repair in pediatric patients in comparison with caudal block. Patients and Methods This prospective randomized study was conducted in Ain Shams University Hospitals; Pediatric Surgery Unit. It included 80 ASA I or II patients undergoing hypospadias (distal penile and mid penile) repair. They were divided into two groups: Group P: Group P penile block (n = 40) received dorsal penile nerve block by using the subpubic approach technique. Group C: Group C caudal block (n = 40) received caudal epidural block using a 22-G needle in the lateral decubitus position. Results There was no statistically significant difference between two groups regarding haemodynamics including MBP (P &lt; 0.05) and HR (P &lt; 0.05). FLACC pain scores were significantly lower in group C compared with group P (P&lt; 0.01). Also, the time to first need for analgesia was significantly lower in group C compared with group P (P&lt; 0.001) .The total rescue analgesic requirement was also significantly lower (P&lt; 0.001) in group C compared with group P.Postoperative time of ambulation was also significantly lower (P&lt; 0.05) in group P compared with group C. Conclusion the current study revealed that caudal block provided significantly prolonged postoperative analgesia, reduced the postoperative analgesic requirements and prolonged time of ambulation as compared with penile block in pediatric patients undergoing hypospadias repair.

Postoperative pain management for circumcision; Comparison of frequently used methods

Objective: To determine the ideal method for postoperative pain management after circumcision by comparing the most frequently used different methods like; dorsal penile block, caudal epidural block, subcutaneous ring block, intravenous paracetamol and intravenous tramadol HCl. Methods: Between May 1st 2015 to May 1st 2016, 500 children between 2-10 year old were circumcised at the department of pediatric surgery of Istanbul Medipol University Health Care Practice & Research Center Sefakoy Hospital. Five groups were formed according to postoperative analgesia methods which were planned to be compared; Group-I. penile block, Group-II. Caudal epidural block, Group-III. subcutaneous ring block, Group-IV as intravenous paracetamol and Group-V as intravenous tramadol HCl. In order to evaluate the postoperative pain levels of children, Children’s Hospital Eastern Ontario Pain Scale (CHEOPS) was filled at 30, 60, 120, 180 minutes after circumcision by a researcher who does not know which method was applied. Results: No significant difference is found between the groups (p>0.05). In the statistical analysis, no significant difference was found in the effect of analgesia methods on CHEOPS scores between 30, 60, 120 and 180 minutes (p>0.05). In parallel with this result, no significant difference was found in the effect of heart beat rates and respiration rate averages between 30, 60, 120 and 180 minutes (p>0.05). Conclusion: It has been shown that none of the five method has any superiority in reducing pain after circumcision and that all five methods can be used. However, we think that side effects of regional anesthesia and systemic analgesic applications should not be ignored. doi: https://doi.org/10.12669/pjms.36.2.505 How to cite this:Munevveroglu C, Gunduz M. Postoperative pain management for circumcision; Comparison of frequently used methods. Pak J Med Sci. 2020;36(2):---------. doi: https://doi.org/10.12669/pjms.36.2.505 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Comparing pain control using oral acetaminophen versus dorsal penile block in neonatal circumcision

Background Circumcision is one of the commonest surgical procedures performed yet the most controversial worldwide. Although various reasons have been suggested in support of circumcision, the pain and stress that accompany it on both neonates and mothers are factors against the procedure. This study compared pain control using oral acetaminophen syrup versus 1% lidocaine injection given as dorsal penile block during neonatal circumcision. Results There were 191 neonates in group A and 195 in group B. The mean age at circumcision was 23.71 (SD ± 20.39) days, and mean weight was 3.33 (SD ± 0.74) kg. The mean pain scores for group A immediately and 1 h after circumcision were 4.26 (SD ± 2.48) and 0.37 (SD ± 1.35), respectively. In group B, the mean pain scores immediately and 1 h after circumcision were 3.31 (SD ± 2.59) and 0.35 (SD ± 1.19), respectively. Conclusion Penile block gives better pain control in comparison with oral acetaminophen syrup, but both agents are effective and can be combined to provide a long-lasting perioperative anaesthesia and analgesia for circumcision in the hospital setting.