caudal block versus dorsal penile nerve block plus ring block for pain management of different surgical techniques of circumcision in infants and children

Conditions: Anesthesia; Anesthesia, Local; Analgesia; Pediatric ALL; Pain, Postoperative; Pain, Acute

Summary: circumcision is one of the most commonly performed operations in the pediatric population and is a painful procedure. circumcision is performed with two popular techniques, plastibell and conventional dissection method (cdm). for intra-operative (op) and post-op pain relief, two commonly used local anesthetic techniques are caudal block (cb) and dorsal penile block (dpnb) plus ring block (rb) at the base of the penis. there are very few randomized controlled trials comparing these two methods of intra-op and post-op pain relief, for different surgical techniques and there is a lack of well-conducted studies comparing the quality of analgesia, need for rescue analgesia in the early post-op period, complications, and parental satisfaction comparing these blocks. furthermore, there is a lot of contradiction in the literature regarding the duration of analgesia produced with these techniques.

circumcision is one of the most commonly performed operations in the paediatric population and is a painful procedure. circumcision is performed with two popular techniques, plastibell and conventional dissection method. two anesthetic techniques are commonly used for intra-operative (op) and post-op pain relief i.e cb and dpnb+rb at the base of the penis. addition of dexmedetomidine to bupivacaine prolongs duration of analgesia of cb. both anaesthesia techniques of pain relief have certain advantages and disadvantages and the superiority of any technique over the other has not been established. there are very few randomized controlled trials comparing these two methods of intra-op and post-op pain relief, for different surgical techniques of circumcision and there is a lack of well-conducted studies comparing the quality of analgesia, need for rescue analgesia in the early post-op period, complications, and parental satisfaction comparing these blocks. furthermore, there is a lot of contradiction in the literature regarding the duration of analgesia produced with these techniques. poorly treated postoperative pain leads to fatigue and metabolic, endocrine, and immunological changes can lead to prolonged convalescence following surgery and is traumatic to the pediatric patients and their parents. in this study, the investigators planned to compare the two most popular methods of pain relief during and after circumcision, along with parents' satisfaction. this research will guide the anesthetists regarding the selection of appropriate techniques of intra-op and post-op analgesia and in light of intra and post-op data; and parents' satisfaction. in this prospective randomized study the investigators plan to compare the quality of intra and post op analgesia and the duration of post-op analgesia produced by cb and dpnb +rb, need of rescue analgesia with both of the techniques of surgery, intra-op hemodynamic variations, residual motor block, and adverse effects and parents' satisfaction with both of the anesthesia and the surgical techniques. research objectives: to evaluate and compare the intra and post-op pain relief under cb and dpnb plus rb in pediatric patients undergoing circumcision with different surgical techniques and assessment of parents' satisfaction this study may guide the anesthetists for the selection of appropriate techniques of intra and post-op analgesia and their complications for different surgical techniques of circumcision and also about parent's satisfaction with the anesthetic technique.

Eligibility criteria:
inclusion criteria: 1. healthy, 2. male, 3. ages 3 months to 4 years, 4. scheduled for circumcision for various indications under ga. exclusion criteria: 1. patients with bleeding or clotting disorders 2. patients with hypospadias, other penile or sacral anomalies 3. patients weight \<3kg. 4. allergy to local anesthetic 5. infection at the site of block 6. pre-existing spinal or neurological disease 7. pain medication within the previous 48 hours