Levobupivacaine for postoperative pain management in circumcision: caudal blocks or dorsal penile nerve block.
OBJECTIVE
In this study, we evaluated the analgesic efficacy and adverse effect profile of levobupivacaine in caudal and DPNB in postcircumcision pediatric patients.


METHODS
Sixty boys between 2-10 years of age undergoing circumcision were enrolled. The patients were divided into two groups: Group C (n=30) and Group P (n=30) were applied caudal block or dorsal penile nerve block (DPNB), respectively. Blocks were performed before surgery as a supplement to general anesthesia with 1 mL kg(-1) 0.25% levobupivacaine. Postoperative pain and sedation scores were assessed on the 10th and 30th minutes, and hours 1-6. The number of pain free patients in the first 6 hours, the duration of analgesia, time to first analgesic administration, walking, micturition, and total paracetamol demands, and length of stay were recorded.


RESULTS
Demographic data were similar between groups. The number of children who spent the first 6 hours pain-free was larger in Group C than Group P (p=0.0001). The time to first analgesic (p=0.000033) and walking (p=0.004) were longer in Group C. There were 14 patients with motor block in Group C (p=0.00007). In view of AUC, FPRS, OPS and MPOPS were significantly better in Group C on the first postoperative 6 hours.


CONCLUSIONS
Caudal block done using levobupivacaine for postoperative pain management in circumcision is more successful than penile block, however there is a significant delay in time to first walking and as might be expected there is an increased risk of motor block.
Department of Anesthesiology and Reanimation, Ufuk University, Faculty of Medicine, Ankara, Turkey. kazakzuleyha@yahoo.com
Züleyha
Z
Kazak Bengisun
Perihan
P
Ekmekci
Ahmet Hakan
AH
Haliloğlu
D000763:Anesthesia, Caudal; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D002648:Child; D002675:Child, Preschool; D002944:Circumcision, Male; D006801:Humans; D000077554:Levobupivacaine; D008297:Male; D009407:Nerve Block; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D010413:Penis / Q000294:innervation; D016896:Treatment Outcome
D000779:Anesthetics, Local; D000077554:Levobupivacaine; D002045:Bupivacaine