Comparison of caudal block and deep penile nerve block for postoperative pain relief in paediatric day-case circumcision.

Abstract

Background: To compare the postoperative analgesia and complications of caudal block and dorsal penile nerve block in children aged 1- 5 years for day case circumcision.

Method: This was a prospective randomized double blind study of paediatric patients aged 1-5 years, who had day-case circumcision at Federal Teaching Hospital, Gombe. Group A had caudal block with 0.5% plain bupivacaine and group B who had dorsal penile nerve block (DPNB) with 0.5% plain bupivacaine. Post-operative pain was assessed using the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS). Patient's age and complications, average pain score, time for the first postoperative analgesia demand and total analgesics consumed in 24 hours were recorded and analyzed.

Results: A total of two hundred and nine (209) patients completed the study, made up of 107 and 102 in group A and B respectively. There was no significant difference in block success rate between the two groups (p = 0.34). Group A had significantly lower average CHEOPS pain score in the immediate postoperative period than the Group B p = 0.02. Group A consumed significantly lower number of paracetamol doses than group B (p = 0.05). There was no significant difference in the incidence of postoperative vomiting between the two groups. The caudal block group had fewer complications than dorsal penile nerve block.

Conclusion: It has shown that caudal block has a higher success rate, better postoperative analgesia and fewer complications than dorsal penile nerve block in children aged 1- 5 years for day case circumcision.