Postoperative analgesia after circumcision in children. Postoperative analgesia after circumcision. A randomized comparison between caudal analgesia and intramuscular morphine in boys. Caudal or dorsal nerve block? A comparison of two local anaesthetic techniques for postoperative analgesia following day case circumcision. Analgesia for circumcision in children. A comparison of caudal bupivacaine and intramuscular buprenorphine. Caudal block for postoperative analgesia in children. Is penile block better than caudal epidural block for postcircumcision analgesia? [Postoperative analgesia for ambulatory surgery in children: a comparison of 2 techniques]. A comparison between local anaesthetic dorsal nerve block and caudal bupivacaine with ketamine for paediatric circumcision.
The analgesic effects of systemically administered diamorphine, caudal analgesia with 0.5% bupivacaine plain and caudal analgesia with 0.5% bupivacaine plain to which morphine sulphate had been added were studied in boys undergoing circumcision. Postoperative analgesia was assessed using a linear analogue scale. The time interval between operation and subsequent analgesic administration and the number of analgesic doses in 24 h were compared. The frequency of vomiting was noted. All three methods provided satisfactory results. The only detectable difference between the groups was a more rapid, but transient, recovery in the group receiving plain bupivacaine only. The frequency of vomiting was high in all groups. Caudal analgesia, with or without the addition of morphine, did not confer any advantage over injected diamorphine, and did not justify the extra time, risk and expense required to carry it out. A randomised blind comparison between caudal analgesia (1.5 mg/kg bupivacaine) and intramuscular morphine (0.15 mg/kg) is reported. Forty boys were studied. Caudal analgesia is shown to be significantly better than morphine by means of a linear analogue scale designed to quantify behaviour immediately after operation. Fifty boys presenting for day case circumcision were allocated randomly to receive either caudal analgesia or dorsal nerve block (DNB) to provide postoperative pain relief. Analgesia was assessed by a single, unbiased observer utilising a three-point scale. Subsequently, parents completed a simple questionnaire. Subjects in the DNB group micturated earlier (P less than 0.05) and stood unaided earlier (P less than 0.025) than patients in the caudal group. The incidence of vomiting was significantly lower in the DNB group (P less than 0.05). There was no significant difference in the duration of analgesia, although that produced in the DNB group tended to wane sooner. It is concluded that DNB provides satisfactory analgesia following circumcision and has specific advantages when compared with caudal analgesia. nan A clinical trial was performed to compare the effects of intramuscular dihydrocodeine with caudal bupivacaine on postoperative pain and recovery in 181 children who had undergone either circumcision, inguinal herniotomy or orchidopexy performed under general anaesthesia. Linear analogues were used in assess level of consciousness and apparent pain. Recovery of consciousness was slower after caudal analgesia. For 90 minutes following circumcision there was significantly less pain and caudal analgesia, but better pain relief could not be demonstrated following inguinal herniotomy and orchidopexy. To compare caudal and penile block for post-operative analgesia in children undergoing circumcision with respect to efficacy, complication rates, and parental satisfaction.
                The study population consisted of 100 ASA 1 and 2 boys aged 3 to 8 years who were undergoing circumcision for religious reasons. In all participants, inhalation anesthesia was administered with oxygen : nitrous oxide (1 : 2) and halothane. The participants were allocated randomly into two groups of 50 children each. Group 1 received penile block and Group 2 caudal block. The penile block was achieved by injecting bupivacaine into the two compartments of the subpubic space, with an additional ventral infiltration of a small volume of bupivacaine along the raphe of the penis. For caudal block, 1 ml.kg(-1) body weight of 0.25% bupivacaine was administered.
                Penile block shortened the induction-incision time and enabled earlier discharge home compared with caudal block. One patient undergoing penile block and nine patients undergoing caudal block vomited.
                Penile and caudal block are equally effective for postcircumcision analgesia and neither is associated with serious complications. Anesthesiologist preference should be the deciding factor in choosing one technique over the other. In 40 children scheduled for circumcision, we studied the quality and the adverse effects of postoperative analgesia induced by caudal block (group 1) or acetaminophen by rectal route (group 2). Study lasted the six first postoperative hours. In recovery room, analgesia was more effective in group 1. Need of analgesic drugs was also lesser in group 1. Incidence of adverse effects was the same in the two groups. Ketamine has been shown to prolong analgesia produced by caudal local anaesthetic block and is now in common use. This study compares caudal block using bupivacaine/ketamine with dorsal nerve block of the penis.
                Sixty boys undergoing elective circumcision were given either 0.5 ml x kg-1 of bupivacaine 0.15% with ketamine 0.5 mg x kg-1 (n = 30) or dorsal nerve block of the penis with bupivacaine 0.5% (n = 30) as a supplement to general anaesthesia. Postoperative pain was assessed by parents using a modified objective pain score, and the time taken to first requirement of analgesia was recorded. Motor weakness, time to first micturition, postoperative nausea and vomiting (PONV), eating habits, sleep disturbance and behaviour were also assessed.
                There was no difference between the groups in time to first requirement for analgesia or number of doses of paracetamol given in the first 24 h. Almost half the boys in the caudal group had motor weakness, and there was a significant increase in time to first micturition in that group. There was no difference between the groups in PONV, eating, sleeping or behavioural disturbance.
                Caudal anaesthesia with bupivacaine/ketamine does not confer any advantage over a dorsal nerve block with the doses used in this study. Because of the higher incidence of side-effects and technique failure in the caudal group, dorsal nerve block is perhaps the preferred technique.