title: Comparison of preventive analgesia techniques in circumcision cases: Dorsal penile nerve block, caudal block, or subcutaneous morphine?
abstract: OBJECTIVE
  To compare 3 different techniques of preventive analgesia before circumcision operations in male children between 6-12 years of age. Our objective was to investigate the duration and quality of postoperative analgesia in patients, who were subject to caudal block technique, dorsal penile nerve block or who were administered subcutaneous morphine.
  
  
  METHODS
  The prospective, randomised, single-blind study was conducted at Ordu University Training and Research Hospital, Ordu, Turkey, from January 1 to June 30, 2015, and comprised boys aged 6-12 years, who were scheduled to undergo circumcision operation. All patients were under general anaesthesia by means of laryngeal masks. The patients were randomised into 3 equal groups. The patients in Group C received caudal block with bupivacaine 0.25% in a total volume of 0.50 ml/kg in lateral position. Those in Group M received injections of 100 mcg/kg of subcutaneous morphine into the deltoid muscle. Patients in Group DP were subjected to dorsal penile nerve block with 1 mg/kg of bupivacaine 0.25%. Intraoperative haemodynamic data, pain and sedation scores, according to Children's Hospital of Eastern Ontorio Pain Scale and Ramsay Sedation Scale, were recorded at postoperative 1st, 6th and 24th hours in all cases.
  
  
  RESULTS
  The 60 subjects in the study were divided into 3 groups of 20(33.3%) each. The overall mean age was 7.75±8.12 years. At 1 hour after surgery; 8(40%) cases in Group M, 5(25%) cases in Group DP, and all the 20(100%) cases in Group C had a pain score <6 (p<0.05). When the scores were analysed 12 hours post-operatively, 5(25%) cases in Group M and 10(50%) cases in Group DP had a pain score >6, while the pain scores of all the 20(100%) cases in Group C were <6 (p<0.01). Among the groups, there was no statistically significant difference regarding the sedation scores (p>0.05).
  
  
  CONCLUSIONS
  Using the three methods, analgesia lasted until 12 hours postoperatively, being more evident in the caudal block group, minimising postoperative stress in children and parents.
authors.affiliation: Department of Anaesthesiology and Reanimation, Ordu University School of Medicine, Turkey.
authors.forename: Ebru
authors.initials: E
authors.lastname: Canakci
authors.affiliation: Department of Anaesthesiology and Reanimation, Ordu University School of Medicine, Turkey.
authors.forename: Ozgur
authors.initials: O
authors.lastname: Yagan
authors.affiliation: Department of Anaesthesiology and Reanimation, Ordu University School of Medicine, Turkey.
authors.forename: Nilay
authors.initials: N
authors.lastname: Tas
authors.affiliation: Ordu University Training and Research Hospital, Clinic of Anaesthesiology and Reanimation, Turkey.
authors.forename: Tugce
authors.initials: T
authors.lastname: Mutlu
authors.affiliation: Department of Urological Surgery, Ordu University School of Medicine, Turkey.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Cirakoglu
authors.affiliation: Department of Urological Surgery, Ordu University School of Medicine, Turkey.
authors.forename: Erdal
authors.initials: E
authors.lastname: Benli
mesh_terms: D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000627:therapeutic use; D002648:Child; D002652:Child Behavior; D002944:Circumcision, Male / Q000379:methods*; D006801:Humans; D007279:Injections, Subcutaneous; D008297:Male; D009020:Morphine / Q000008:administration & dosage* / Q000627:therapeutic use; D009407:Nerve Block / Q000379:methods; D010146:Pain / Q000188:drug therapy* / Q000517:prevention & control; D010413:Penis / Q000187:drug effects / Q000601:surgery; D011446:Prospective Studies
chemical_list: D000779:Anesthetics, Local; D009020:Morphine
keywords: Preventive analgesia, Caudal block, Dorsal penile nerve block, Morphine. 