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Ultrasound-guided pudendal nerve block as good as penile nerve block for analgesia during pediatric circumcision
Canada: A study comparing ultrasound-guided pudendal nerve block and penile nerve block under general analgesia for pediatric circumcision found that both provide comparable postoperative analgesia, as evidenced by low opioid consumption and pain scores.
The surgeon satisfaction, however, was shown to be higher in the pudendal group. The findings appeared in the BMJ journal Regional Anesthesia & Pain Medicine.
Circumcision is a ceremonial tradition or a religious rite in many cultures and is most common in Islamic and Jewish faiths. Circumcision is a surgery performed to remove the skin covering the penis' end, called a foreskin. The procedure is performed only on healthy babies. As the process is painful, the AAP (American Academy of Pediatrics) recommends using local anesthesia for newborn circumcision.
There is still debate on the optimal analgesia choice for circumcision. The dorsal penile nerve block is superior to topical and caudal analgesia. The ultrasound-guided pudendal nerve block has recently been popularized. To clarify which is a better choice, Frédérique Boisvert-Moreau from Canada and colleagues conducted a randomized, blinded clinical trial to compare an ultrasound-guided dorsal penile nerve block (group penile) with an ultrasound-guided pudendal nerve block (group pudendal) under general anaesthesia for pediatric circumcision.
The trial included prepubertal males aged 1–12 years undergoing elective circumcision. They were randomized to either group pudendal or group penile. The authors examined postoperative FLACC scores (face, legs, activity, cry, consolability) (primary outcome). The secondary outcomes comprised analgesic consumption during the first 24 hours, the parent's postoperative pain measure, time to perform the block, the surgeon's and parent's satisfaction, postanesthesia care unit and until discharge, and hemodynamic changes intraoperatively.
A total of 155 patients, 78 in group penile and 77 in group pudendal, were included for analysis. The mean age was 7.3 years old.
The authors reported the following findings:
- FLACC scores were not statistically different between groups.
- Surgeon satisfaction was higher with group pudendal (90.8% vs 56.6% optimal).
- Intraoperative hemodynamic changes (>20% rise of heart rate or blood pressure) were higher in group pudendal (33.8% vs 9.0%), as was intraoperative fentanyl use (1.3 vs 1.0 μg/kg). Other secondary outcomes were not statistically different.
"The findings showed that both ultrasound-guided blocks, conducted under general anesthesia, provided similar analgesia for pediatric circumcision, as evidenced by low opioid consumption and pain scores," the authors wrote. "In the pudendal group, surgeon satisfaction was higher."
Reference:
Boisvert-Moreau F, Turcotte B, Albert N, et alRandomized controlled trial (RCT) comparing ultrasound-guided pudendal nerve block with ultrasound-guided penile nerve block for analgesia during pediatric circumcisionRegional Anesthesia & Pain Medicine Published Online First: 17 November 2022. doi: 10.1136/rapm-2022-103785
MSc. Biotechnology
Medha Baranwal joined Medical Dialogues as an Editor in 2018 for Speciality Medical Dialogues. She covers several medical specialties including Cardiac Sciences, Dentistry, Diabetes and Endo, Diagnostics, ENT, Gastroenterology, Neurosciences, and Radiology. She has completed her Bachelors in Biomedical Sciences from DU and then pursued Masters in Biotechnology from Amity University. She has a working experience of 5 years in the field of medical research writing, scientific writing, content writing, and content management. She can be contacted at  editorial@medicaldialogues.in. Contact no. 011-43720751
Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751