Introduction Optimal analgesia for circumcision is still debated. The dorsal penile nerve block has been shown to be superior to topical and caudal analgesia. Recently, the ultrasound-guided pudendal nerve block (group pudendal) has been popularized. This randomized, blinded clinical trial compared group pudendal with ultrasound-guided dorsal penile nerve block (group penile) under general anesthesia for pediatric circumcision.
Methods Prepubertal males aged 1–12 years undergoing elective circumcision were randomized to either group. The primary outcome was postoperative face, legs, activity, cry, consolability (FLACC) scores. Our secondary outcomes included parent’s postoperative pain measure, analgesic consumption during the first 24 hours, surgeon’s and parent’s satisfaction, time to perform the block, hemodynamic changes intraoperatively and total time in postanesthesia care unit and until discharge.
Results A total of 155 patients were included for analysis (77 in group pudendal and 78 in group penile). Mean age was 7.3 years old. FLACC scores were not statistically different between groups (p=0.19–0.97). Surgeon satisfaction was higher with group pudendal (90.8% vs 56.6% optimal, p<0.01). Intraoperative hemodynamic changes (>20% rise of heart rate or blood pressure) were higher in group pudendal (33.8% vs 9.0%, p<0.01) as was intraoperative fentanyl use (1.3 vs 1.0 μg/kg, p<0.01). Other secondary outcomes were not statistically different.
Discussion Both ultrasound-guided blocks, performed under general anesthesia, provide equivalent postoperative analgesia for pediatric circumcision as evidenced by low pain scores and opioid consumption. Surgeon satisfaction was higher in the pudendal group.
Trial registration number NCT03914365.
- analgesics, opioid
- regional anesthesia
- pain, postoperative
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
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FB-M and BT are joint first authors.
Contributors AB is responsible for the overall content as guarantor. I accept full responsibility for the finished work and/or the conduct of the study. BT helped design the study, conduct the study, analyze the data, and write the manuscript. FB-M helped design the study, conduct the study, analyze the data, and write the manuscript. NS helped analyze the data. NA helped design the study, conduct the study, analyze the data, and write the manuscript. KM helped design the study, conduct the study, analyze the data, and write the manuscript. AB helped design the study, conduct the study, analyze the data, and write the manuscript.
Funding This study was funded by CHU de Quebec Fondation.
Competing interests No authors have any competing interests or disclosure with regard to this study.
Provenance and peer review Not commissioned; externally peer reviewed.
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