Comparison between the caudal block and other methods of postoperative pain relief in children undergoing circumcision: A prospective randomized study

Title : Comparison between the caudal block and other methods of postoperative pain relief in children undergoing circumcision: A prospective randomized study

Abstract:

Background: 
Caudal block (CB), dorsal nerve penile block (DPNB) and systemic opioids are common techniques used in pediatric surgeries to provide analgesia for penile surgery such as circumcision. This study aimed to compare the effectiveness of the CB with other methods of postoperative pain release.

Methods: 
This prospective, randomized, case-controlled trial was conducted in the main pediatric operation theater and post-anesthesia recovery unit (PACU). Successive children aged 3 months to 3 years who had American Society of Anesthesiologists Physical Status classification I and had undergone elective circumcision surgery were recruited. Children were randomized to one of 3 groups, CB (Group A), systemic opioids (Group B), or DPNB (Group C). Patients were injected with 0.75 to 1 mL/kg 0.25% bupivacaine in group A, fentanyl 1-3 μg/kg in group B, and 0.3 mL/kg 0.25% bupivacaine in group C. The need for analgesia and parental satisfaction were assessed during the first 6 hours postoperatively. The Face, Leg, Activity, and Cry Consolability (FLACC) pain scale and behaviors were used to observe and compare the three groups.

Results: 
Participants’ heart rate was higher among group C, while it was the lowest in group A during the observation period (P<0.05). High pain, crying, movement, agitation, and posture scales were observed among group C followed by group B, while group A showed the lowest scores. Patients who received penile block had expressed a longer time to achieve the “relaxed and comfortable” status but with no significant difference with the other two groups. Moreover, types of regional block were mainly the significant predictor of pain scale at 5, 10, 20, 30, and 60 minutes postoperative.

Conclusions: 
For postoperative pain management, the study has shown that CB is proven to produce higher levels of analgesia and a longer period of pain release compared to penile block, even if both methods help relieve pain during pediatric surgical procedures.

Keywords: Caudal; Pediatric; Penile block; Opioids; Circumcision; Postoperative analgesia

Biography:

Dr. Zeana Amer Gawe, MBBCH, MD, SABA, is a Specialist in Anesthesia and Intensive Care with over 22 years of experience. She is currently serving as a Specialist in the Anesthesia Department at IBN ALNAFEES Hospital in Manama, Bahrain. Dr. Gawe holds a Bachelor’s degree in Medical Practice, a Master’s degree in General Anesthesia, Intensive Care, and Pain Management (since 2002), and the Arab Board certification in General Anesthesia and Pain Management. Previously, she worked at Salmaniya Medical Complex as a Specialist in Anesthesia and Pain Management, where she conducted and published research on pediatric anesthesia and pain relief during and after operations, with the findings recorded on Clinical Trials.gov. She is also a member of the Research Council. Her ORCID number is 0000-0001-6402-1685. She has contributed significantly to academic research, focusing on pediatric anesthesia and pain management. Her work includes a prospective randomized trial titled "The Effect of Caudal Anesthesia Block on Perioperative Pain Control and Reduction of the Anesthetic Agent in Pediatric Infraumbilical Surgery," co-authored with Hasan Mohamed Isa, Muatasem Mohamed Almashaur, and Fayza Haider. This study was published in the journal Anesthesia: Essays and Research (DOI: 10.4103/aer.aer_64_22) and is registered on Clinical Trials. gov with the ID NCT05581940. Another notable study, "Comparison between the Caudal Block and Other Methods of Postoperative Pain Relief in Children Undergoing Circumcision: A Prospective Randomized Study," was published in Anesthesia and Critical Care (2023) 
(DOI: 10.26502/acc.063) and is also registered on ClinicalTrials.gov under ID NCT06086106.