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Randomized controlled trial (RCT) comparing ultrasound-guided pudendal nerve block with ultrasound-guided penile nerve block for analgesia during pediatric circumcision
  1. Frédérique Boisvert-Moreau1,
  2. Bruno Turcotte2,
  3. Natalie Albert1,
  4. Narcisse Singbo3,
  5. Katherine Moore2 and
  6. Ariane Boivin1
  1. 1Department of Anesthesia, CHU de Québec-Université Laval, Quebec, Quebec, Canada
  2. 2Department of Surgery, CHU de Québec-Université Laval, Quebec, Quebec, Canada
  3. 3Clinical and Evaluative Research Platform, Research Center, CHU de Québec-Université Laval, Quebec, Quebec, Canada
  1. Correspondence to Dr Ariane Boivin, CHU de Québec-Université Laval, Quebec G1R 2J6, Quebec, Canada; ariane.boivin.2{at}ulaval.ca

Abstract

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
  • ultrasonography
  • pediatrics
  • 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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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • FB-M and BT are joint first authors.

  • Twitter @nattalbert

  • 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.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.