title: Ring block with levobupivacaine 0.25% and paracetamol vs. paracetamol alone in children submitted to three different surgical techniques of circumcision: A prospective randomized study.
abstract: BACKGROUND
  circumcision in children is a painful procedure. We aim compare the intraoperative and postoperative efficacy of three different surgical procedures of the ring block using levobupivacaine 0.25% combined with rectal paracetamol as opposed to rectal paracetamol alone.
  
  
  METHODS
  the study included 106 boys scheduled to undergo circumcision. The patients were randomly assigned within two groups to receive either ring block with levobupivacaine 0.25% and rectal paracetamol 30 mg/kg, or rectal paracetamol 30 mg/kg alone. The following surgical procedures were performed: sutureless proctoplasty, preputial plasty, and conventional circumcision. The efficacy of intraoperative analgesia was estimated on the basis of increases in heart rate and mean arterial pressure. Postoperatively, children were assessed for pain, pain-free (PF) period, and the total doses of analgesics administered during hospitalization, on the day after discharge, and on the first and second postoperative days.
  
  
  RESULTS
  all children remained stable during anesthesia. Postoperatively, the mean pain score did not show statistical differences between the groups. Children who received combined analgesia had a longer PF period (P < 0.001). However, the total doses of paracetamol administered during the observational period showed no differences. Children undergoing sutureless prepuceplasty received lower doses of paracetamol postoperatively (P < 0.001).
  
  
  CONCLUSIONS
  subcutaneous ring block either with levobupivacaine 0.25% plus rectal paracetamol or rectal paracetamol alone provides adequate intraoperative and postoperative analgesia in circumcised children. However, combined analgesia allows a longer PF period. The need for less analgesic administration in children undergoing sutureless prepuceplasty could mean that the circumcision techniques might be a mitigating factor in terms of pain.
authors.affiliation: Department of Surgery, ATTIKO University Hospital, Athens-Greece.
authors.forename: Nick
authors.initials: N
authors.lastname: Zavras
authors.affiliation: Department of Pediatric Surgery, Penteli, General Children's Hospital, P. Penteli, Athens-Greece.
authors.forename: Stella
authors.initials: S
authors.lastname: Tsamoudaki
authors.affiliation: Department of Pediatric Surgery, Penteli, General Children's Hospital, P. Penteli, Athens-Greece.
authors.forename: Efstratios
authors.initials: E
authors.lastname: Christianakis
authors.affiliation: Department of Surgery, ATTIKO University Hospital, Athens-Greece.
authors.forename: Demetrios
authors.initials: D
authors.lastname: Schizas
authors.affiliation: Department of Surgery, Laiko University Hospital, Athens-Greece.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Pikoulis
authors.affiliation: Department of Nursing A, Technological and Educational Institute of Athens-Greece.
authors.forename: Helen
authors.initials: H
authors.lastname: Kyritsi
authors.affiliation: Department of Pediatrics, Athens University Medical School, Aghia Sophia Children's Hospital, Athens-Greece.
authors.forename: George
authors.initials: G
authors.lastname: Chrousos
keywords: Circumcision; levobupivacaine; paracetamol