CIRCUMCISION IN CHILDREN WITH PENILE BLOCK ALONE

Surgical procedures in children are usually performed with the patient under general anesthesia. For circumcision an additional dorsal penil e nerve block is used for postoperative analgesia. We retrospectively evaluated dorsal penile nerve block as the only analgesic technique fo r the relief of intraoperative pain in children undergoing circumcisio n. For 6 months dorsal penile nerve block was performed in 454 childre n 3 to 11 years old (mean 8.15 +/- 2.08 years) as the sole preoperativ e anesthesia. All boys were considered to have had good preoperative a nalgesia. 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 achi eved. The overall average operating time was 7.2 +/- 2.6 minutes (rang e 6 to 25). General anesthesia was added in 13 patients, representing a dorsal penile nerve block failure rate of 2.9%. Four boys suffered f rom 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 remaini ng 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 t he 13 children and 6.8 +/- 1.1 minutes (range 6 to 15) in the remainin g 441 (p <0.001). During the recovery period, only children from the g eneral anesthesia group suffered from nausea and vomiting (9), and pai n, 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 dorsa l 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 analgesi a for circumcision in children, particularly those older than 6 years.