Volume : 6, Issue : 6, June - 2017

A comparison of Dorsal penile nerve block vs. Caudal block for circumcision in children in a rural setup.

Dr. Nambiraj Konar, Dr. Bindiya Salunke, Dr. Ketki Pathak

Abstract :

<p>&nbsp;One of the commonly performed urological procedures in children is Circumcision. Although a simple procedure, it is associated with lot of pain. Regional techniques like dorsal penile nerve block (DPNB) and caudal block are low cost and simple methods&nbsp; to&nbsp; provide effective analgesia for circumcision.</p> <p class="MsoNormal"><o:p></o:p></p> <p class="MsoNormal">The purpose of this article was to analyze the outcome of DPNB and caudal block in terms of analgesic adequacy and post operative pain scores in patients undergoing circumcision.<o:p></o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt"><b>Methodology:<o:p></o:p></b></p> <p class="MsoNormal">A randomized, double-blind, trial was performed at B.K.L. Walawalkar hospital, Dervan. 40 children aged 3 to 12 years of ASA physical status I or II&nbsp; for elective circumcision under general anaesthesia, were randomized to have a DPNB (Group A = 20) &nbsp;or to undergo Caudal epidural block (Group B = 20) with 0.5 ml/kg of 0.25% Bupivacaine. These patients in addition received standard analgesic comprising 2 mg/kg of Diclofenac sodium suppository postoperatively. Each patient was assessed at 0 and 30 min and then at hourly intervals for 6 hours postoperatively by an independent observer for pain using FLACC Pain Scale (A behavioral scale for scoring postoperative pain in young children), total analgesic consumption and time for the first rescue analgesic request. Oral Paracetamol (15mg/kg) was given to patients as rescue analgesia when FLACC score was 5 or above.<o:p></o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt"><b>Results:<o:p></o:p></b></p> <p class="MsoNormal">The results showed that both DPNB and Caudal block were equally effective in providing post operative analgesia. No significant difference was found in FLACC scores between the groups. The mean time for first recue analgesia was comparable (Group A = 270 min, Group B = 300 min, &nbsp;P = 0.589 )and both the groups required similar doses of paracetamol as rescue analgesic in the first 6 hours after surgery (Group A = 112.11, Group B = 114.27,&nbsp; P = 0.651)<o:p></o:p></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt"><b>Conclusion:<o:p></o:p></b></p> <p><span style="font-size:12.0pt;line-height:115%;font-family:&quot;Times New Roman&quot;,serif;&#10;mso-fareast-font-family:&quot;Times New Roman&quot;;mso-fareast-theme-font:minor-fareast;&#10;mso-ansi-language:EN-US;mso-fareast-language:EN-US;mso-bidi-language:AR-SA">Both DPNB and caudal block provide for comparable pain scores and post operative analgesia</span></p>