Selected abstracts from the Annual Meeting, Society of Paediatric Anaesthetists in New Zealand and Australia (SPANZA). Held 6–9 November 2008 in the Hunter Valley, NSW, Australia. A retrospective analysis of three different regional anaesthetic techniques for male circumcision
Authors: Sandeman D. , Reiner D. , Dilley A. , Bennett M. , Kelly K. 
Published: April 2009

Postoperative analgesia for male circumcision surgery has been traditionally provided by a landmark based Dorsal Penile Nerve Block (DPNB‐LM) (1) or by Caudal Epidural Analgesia (CEA). In this study we report on a retrospective analysis of the effectiveness and safety of CEA, DPNB‐LM and Dorsal Penile Nerve block – Ultrasound guided (DPNB‐US) in our institution over a 6 year period. Information was gathered from each patient's medical record. A total of 216 circumcisions were performed on patients aged from 5 months to 15 years. A total of 115 patients received CEA, 46 DPNB‐LM and 55 DPNB‐LM. Patients in the DPNB‐LM group required rescue morphine administration in the Recovery unit more frequently (30.4%) than either the DPNB‐US (3.5%) or CEA groups (3.6%). Similarly, the DPNB‐LM group required a larger total dose of morphine, and had longer recovery ward stays than CEA or DPNB‐US groups. Time to first analgesia was greatest for the CEA group whilst there was no significant difference between time to first analgesia for DPNB‐LM and DPNB‐US. About 63% of patients in the DPNB‐LM group, 1.7% of CEA and 5.5% of the DPNB‐US required intraoperative opiates (P<0.0001). There was no difference in time to hospital discharge.

Patient demographics, premedication and procedure duration

CEA n = 115
DPNB‐LM n = 46
DPNB‐US n = 55
P‐value (mean comparison byanova, proportions by Chi‐square)

ASA 1 (n) (%)
106 (92.2)
41 (89.1)
46 (83.6)
0.5

Mean weight in (kg) ±sd
14 ± 6
23 ± 17
21 ± 17
<0.0001

Mean age (years) ±sd
3 ± 2
5 ± 4
5 ± 4
<0.0001

Paracetamol premedication (n) (%)
109 (95)
46 (100)
49 (89)
0.06

Midazolam premedication (n) (%)
92 (80)
29 (63)
39 (71)
0.07

Mean duration of procedure in (min) ±sd
49 ± 11
50 ± 14
51 ± 12
0.64

Outcomes

Outcomes
CEA n = 115
DPNB‐LM n = 46
DPNB‐US n = 55
P‐value
Difference (confidence interval) and individual P‐value after correction for multiple comparison

Patients requiring morphine in recovery (%)
4 (3.6)
14 (30.4)
2 (3.5)
<0.0001

Mean morphine in recovery (μg/kg ±sd)
1.7 ± 10.1
16.9 ± 39.2
0.5 ± 2.7
<0.001
DPNB‐LM v Caudal 15.2 (7.1‐23.2) (P<0.0001)

DPNB‐LM v DPNB‐US 16.4 (7.2‐25.6) (P=0.0001)

DPNB‐US v Caudal 1.2 (‐6.3‐8.8) (P=0.9)

Mean Duration of recovery ward stay (min) ±sd
69 ± 23
84 ± 49
62 ± 16
0.0009
DPNB‐LM v Caudal 14.8 (2.6‐26.9) (P=0.01)

DPNB‐LM v DPNB‐US 22.1 (8.2‐36.0) (P=0.0007) DPNB‐US v Caudal 7.3 (‐4.1‐18.7) (P=0.3)

Mean Time to first analgesia (min) ±sd
179 ± 89
90 ± 76
132 ± 68
0.0004
DPNB‐LM v Caudal 89.5 (38.2‐140.8) (P=0.0002)

DPNB‐LM v DPNB‐US 42.1 (11.1‐95.2) (P=0.2) DPNB‐US v Caudal 47.4 (‐3.8‐98.7) (P=0.0.08)

Intraoperative opiates (n) (%)
2 (1.7%)
29 (63%)
3 (5.5%)
<0.0001

Mean Time to hospital discharge (min) ±sd
273 ± 137
296 ± 189
250 ± 158
0.3

PONV requiring treatment (n)
10
5
0
0.06

Reference1 Sandeman DJ, Dilley AV. Ultrasound guided dorsal penile nerve block in children. Anaesth Int Care 2007; 35(2): 266–269.