Okmeydanı Training and Research Hospital, Department of Anesthesiology and Reanimation, Istanbul, Turkey.
Okmeydanı Training and Research Hospital, Department of Pediatric Surgery, Istanbul, Turkey.
J Pediatr Urol. 2020 Feb;16(1):99-106. doi: 10.1016/j.jpurol.2019.10.020. Epub 2019 Oct 30.
Circumcision can be performed under sedo-analgesia, general anesthesia, or regional anesthesia. It may cause serious postoperative pain and patients often require additional analgesia. Dorsal penile nerve block (DPNB) and caudal epidural block are commonly used regional anesthesia methods to provide effective postoperative pain control in circumcision.
In this prospective observational study, we aimed to investigate the postoperative analgesic efficiency of DPNB with the ultrasound (US)-guided in-plane technique and single-dose caudal epidural block in circumcision.
Male patients aged 4-12 years in the ASA I-II group, who were scheduled for circumcision, were included in the study. A caudal epidural block or US-guided DPNB with the in-plane technique was administered under general anesthesia before the operation. Postoperative pain was evaluated using the Children's Hospital Eastern Ontario Pain Scale (CHEOPS) and Faces Pain Scale-Revised (FPS-R). Postoperative analgesic need and parental satisfaction were also noted.
There were 140 patients in our study. The number of patients receiving a caudal block (n = 70) and DPNB block (n = 70) was equal. Side effects were only seen in five patients in the caudal group. No side effects were seen in patients in the DPNB group. Analgesics were required in 3.6% of the patients in the caudal group and none of the patients in the DPNB group postoperatively. CHEOPS mean scores in the caudal block group were found to be statistically significantly higher than in the penile block group. FPS-R 24th hour mean score was statistically significantly higher in the caudal block group (P < 0.001). Postoperative parental satisfaction in the penile block group was found to be statistically significantly better than in the caudal block group (P = 0.028).
This study demonstrated that DPNB conducted with the US-guided in-plane technique was more effective than caudal block in providing postoperative analgesia. The parental satisfaction was also higher, and no side effect was seen in the DPNB group.
DPNB conducted with the US-guided in-plane technique is a simple and safe regional anesthesia method used to provide effective postoperative analgesia for male circumcision. Complications related to DPNB can be prevented with the help of the real-time imaging provided by ultrasound.
包皮环切术可在镇静-镇痛、全身麻醉或区域麻醉下进行。它可能会引起严重的术后疼痛，患者通常需要额外的镇痛。阴茎背神经阻滞（DPNB）和骶管阻滞是常用的区域麻醉方法，可在包皮环切术中提供有效的术后疼痛控制。
在这项前瞻性观察研究中，我们旨在研究超声（US）引导下平面内技术的 DPNB 与单次骶管阻滞在包皮环切术中的术后镇痛效果。
纳入年龄在 4-12 岁、ASA I-II 级、拟行包皮环切术的男性患者。在手术前全身麻醉下进行骶管阻滞或 US 引导下平面内 DPNB。使用儿童东部安大略省疼痛量表（CHEOPS）和面部疼痛量表修订版（FPS-R）评估术后疼痛。还记录了术后镇痛需求和父母满意度。
本研究共纳入 140 例患者。接受骶管阻滞（n=70）和 DPNB 阻滞（n=70）的患者数量相等。骶管阻滞组仅 5 例患者出现不良反应。DPNB 组患者均无不良反应。骶管阻滞组术后有 3.6%的患者需要使用镇痛药，而 DPNB 组则没有。骶管阻滞组的 CHEOPS 平均评分明显高于 DPNB 组。骶管阻滞组 24 小时 FPS-R 平均评分明显高于 DPNB 组（P<0.001）。DPNB 组的术后父母满意度明显高于骶管阻滞组（P=0.028）。
本研究表明，与骶管阻滞相比，US 引导下平面内 DPNB 更能有效提供术后镇痛。DPNB 组的父母满意度也更高，且无不良反应。
US 引导下平面内 DPNB 是一种简单、安全的区域麻醉方法，可有效提供男性包皮环切术的术后镇痛。DPNB 可通过超声提供的实时成像来预防与 DPNB 相关的并发症。
