Intraoperative and postoperative analgesia with subcutaneous ring block of the penis with levobupivacaine for circumcision in children.

The purpose of the study is to evaluate both the efficacy of ring block of the penis with levobupivacaine in preventing intraoperative and postoperative pain associated with circumcision in children and the quality of the recovery. Thirty boys aged 3 - 12 years who underwent circumcision under general anaesthesia as day case patients were allocated randomly to receive either a subcutaneous ring block with levobupivacaine or intravenous fentanyl (2 microg/kg) and paracetamol (30 mg/kg) rectally, after induction of anesthesia but before surgery. The efficacy of intraoperative analgesia was estimated using the heart rate and alterations in blood pressure. The quality of the recovery was assessed based on the Aldrete Scoring System (First Value and Time of Maximum Value were recorded). Postoperative pain was estimated using a four degree scale by nurses in the Postanaesthesia Care Unit and over the next 24 hours by the parents. Paracetamol was given depending on the pain score and the time of first dose given was recorded. The quality of postoperative analgesia was based on the children's activity and mobilisation. The ring block group showed intraoperative cardiovascular stability and a faster and better recovery (p < 0.0005) while the postoperative analgesia tended to be longer and more adequate, although that no statistically significant difference was noted (p < 0.1).