Circumcision in Children With Penile Block Alone

Abstract

Surgical procedures in children are usually performed with the patient under general anesthesia. For circumcision an additional dorsal penile nerve block is used for postoperative analgesia. We retrospectively evaluated dorsal penile nerve block as the only analgesic technique for the relief of intraoperative pain in children undergoing circumcision. For 6 months dorsal penile nerve block was performed in 454 children 3 to 11 years old (mean 8.15 +-/2.08 years) as the sole preoperative anesthesia. All boys were considered to have had good preoperative analgesia. No major complications were reported. Block related hematoma was noted in 12 patients (2.6%) and mild local edema occurred in 83 (18.3%). There was no excessive bleeding and hemostasis was easily achieved. The overall average operating time was 7.2 +-/2.6 minutes (range 6 to 25). General anesthesia was added in 13 patients, representing a dorsal penile nerve block failure rate of 2.9%. Four boys suffered from erratic pain, while no objective cause of failure was recorded in the remaining 9. Average patient age was 5.8 +-/2.2 years (range 3 to 10) in the 13 boys and 8.2 +-/2 years (range 3 to 11) in the remaining 441 patients (p <0.001). Failure was more frequent in children 3 to 5 years old (15.5%) than in those older than 6 years (1.5%, p <0.05). Average operating time was 20.7 +-/2.8 minutes (range 15 to 25) in the 13 children and 6.8 +-/1.1 minutes (range 6 to 15) in the remaining 441 (p <0.001). During the recovery period, only children from the general anesthesia group suffered from nausea and vomiting (9), and pain, agitation and fear (6 boys 3 to 6 years old). Average recovery room time was 38.7 +-/7.4 minutes (range 30 to 60) in children with dorsal penile nerve block alone and 95 +-/9.8 minutes (range 85 to 120) in those with additional general anesthesia (p <0.001). We conclude that dorsal penile nerve block alone provides good intraoperative analgesia for circumcision in children, particularly those older than 6 years.