A retrospective audit of three different regional anaesthetic techniques for circumcision in children.
Postoperative analgesia for male circumcision surgery has been traditionally provided by a landmark-based dorsal penile nerve block (DPNB-LM) or by caudal epidural analgesia (CEA). In this study we report on a retrospective analysis of the effectiveness and safety of CEA, DPNB-LM and ultrasound-guided dorsal penile nerve block (DPNB-US) in our institution over a six-year period. Information was gathered from each patient's medical record. A total of 216 circumcisions were performed on patients aged from five months to 15 years. One hundred and fifteen patients received CEA, 46 DPNB-LM and 55 DPNB-US. Patients in the DPNB-LM group required rescue morphine administration in the recovery unit more frequently (30.4%) than either the DPNB-US (3.5%) or CEA groups (3.6%). Similarly, the DPNB-LM group required a larger total dose of morphine, and had longer recovery ward stays than CEA or DPNB-US groups. Time to first analgesia was greatest for the CEA group while there was no significant difference between time to first analgesia for DPNB-LM and DPNB-US. Sixty-three percent of patients in the DPNB-LM group, 1.7% of CEA and 5.5% of the DPNB-US required intraoperative opiates (P < 0.0001). There was no difference in time to hospital discharge.
Departments ofAnaesthesia and Surgery, Sydney Children's Hospital, Sydney, New South Wales, Australia.
D J
DJ
Sandeman
D
D
Reiner
A V
AV
Dilley
M H
MH
Bennett
K J
KJ
Kelly
D000293:Adolescent; D015360:Analgesia, Epidural / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D002944:Circumcision, Male; D006801:Humans; D007223:Infant; D008297:Male; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000628:therapy*; D012189:Retrospective Studies