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Abstract
Background and Aims One of the most frequent surgical procedures in the pediatric population is circumcision—following which postoperative pain could be stressful. Usually, the most common approach is combining regional anesthesia techniques such as landmark dorsal penile nerve block (DPNB) with general anesthesia (GA). The hypothesis of this study investigates ultrasound-guided DPNB plus sedation in spontaneous breathing.
Methods Our ethical committee approved this study Prot. #5848. 58 children who underwent circumcision at our University-Hospital between January 2016 and December 2019 were included: 35 received GA plus DPNB performed by the surgeon with a landmark technique; 23 were sedated in spontaneous breathing and the anesthetist performed an ultrasound-guided DPNB with the probe positioned transversally at the base of the penis – in-plane – to visualize the local anesthetic spread. The statistical analysis was achieved with commercially available software (MedCalc version 19.0.7, bvba, Ostend, Belgium).
Results Age, weight, and height were comparable between the two groups. Children who received ultrasound-guided DPNB had a statistically significant lower time to discharge from the operating room with faster awakening, lower pain levels immediately after surgery, less intraoperative opioid consumption with a lower rate of complications after 72 hours.
Conclusions The ultrasound-guided DPNB associated with sedation and spontaneous breathing is a safe and effective strategy for the management of intra- and postoperative pain in children.