Assessment of pain and hemodynamic response in older children undergoing circumcision: comparison of eutectic lidocaine/prilocaine cream and dorsal penile nerve block.
OBJECTIVE
To evaluate whether dorsal penile nerve block (DPNB) or local topical anesthesia (LT) provided better postoperative analgesia and less hemodynamic stimulation during and after circumcision surgery with Plastibell in older children.


METHODS
Forty-one subjects (age: 2-13 years) undergoing circumcision with Plastibell were randomly divided into LT and DPNB groups. Inhalation induction was performed with an 8% end-tidal sevoflurane concentration. In the LT group, a eutectic ointment of 5% lidocaine and 5% prilocaine was applied to the foreskin 1 h before surgery. At 10 min after anesthesia induction, the end-tidal sevoflurane concentration was decreased to 2%. In the other group, a DPNB was performed with 0.5% bupivacaine (1 mg/kg). Heart rate (HR), respiratory rate, mean arterial pressure (MAP), and involuntary movements were evaluated at anesthesia induction (T0), 1 min after DPNB (T1), 1 min after incision (T2), and 1 min after surgery (T3). Pain was evaluated at 1 and 24 h after surgery, and complications were evaluated at 24 h after surgery.


RESULTS
The groups were homogeneous with respect to age, weight, glans diameter, penile length, Kayaba classification, and surgical duration. The LT group showed increased HR (p = 0.073) and MAP (p = 0.046) at T2 as compared to T0. No hemodynamic changes were observed in the HPDB group. The LT group showed a higher pain score at 1 h after surgery than the DPNB group, whereas the DPNB group had a higher incidence of hematoma (p = 0.02) at 24 h after surgery.


CONCLUSIONS
Anesthesia with 5% lidocaine and 5% prilocaine cream during circumcision of older children with Plastibell under general anesthesia with sevoflurane does not provide satisfactory perioperative hemodynamic stability or postoperative analgesia.
Department of Anesthesiology, Federal University of Juiz de Fora, Brazil. mfonsecasalgado@hotmail.com
Marcello Fonseca
MF
Salgado Filho
Hedelberto Barbosa
HB
Gonçalves
Lúcio Huebra
LH
Pimentel Filho
Daniel da Silva
Dda S
Rodrigues
Izabela Palitot
IP
da Silva
André
A
Avarese de Figueiredo
José Murillo
JM
Bastos Netto
D000293:Adolescent; D000779:Anesthetics, Local; D002648:Child; D002675:Child, Preschool; D002944:Circumcision, Male; D006439:Hemodynamics; D006801:Humans; D008012:Lidocaine; D000077442:Lidocaine, Prilocaine Drug Combination; D008297:Male; D009407:Nerve Block; D009824:Ointments; D010149:Postoperative Pain / Q000517:prevention & control*; D011318:Prilocaine; D011446:Prospective Studies; D060525:Pudendal Nerve
D000779:Anesthetics, Local; D000077442:Lidocaine, Prilocaine Drug Combination; D009824:Ointments; D011318:Prilocaine; D008012:Lidocaine