Penile Blood Flow Characteristics Following Caudal or Penile Block

Study Overview
=================
Brief Summary
-----------------
Pediatric urologic surgery is generally accompanied by use of a caudal or penile block for analgesia. A caudal block is performed by injecting local anesthetic in the low epidural space while a penile block is performed by injecting local anesthetic above the pubic symphysis. Local anesthetic in the epidural space is known to caudal vasodilation interiorly. It is unknown as to whether this vasodilation results in alteration in flow to the penile tissue and potentially changes tissue characteristics. The aim of this study is to measure blood ultrasound velocity in the dorsal penile artery and vein before and after a block.

Detailed Description
-----------------
Pediatric urologic surgery is generally accompanied by use of a caudal or penile block for analgesia. A caudal block is performed by injecting local anesthetic in the low epidural space while a penile block is performed by injecting local anesthetic above the pubic symphysis. Local anesthetic in the epidural space is known to caudal vasodilation interiorly. It is unknown as to whether this vasodilation results in alteration in flow to the penile tissue and potentially changes tissue characteristics. The aim of this study is to measure blood ultrasound velocity in the dorsal penile artery and vein before and after a block.

Official Title
-----------------
Penile Blood Flow Characteristics Following Caudal or Penile Block

Conditions
-----------------
The Aim of This Study is to Measure Blood Flow Before and After a Block

Intervention / Treatment
-----------------
* Procedure: Block performed
* Device: LMA placement


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Children ages <7 years undergoing circumcision at TCH Penile or Caudal block to be performed at discretion of anesthesiology/Urology providers ASA classification1,2 use of laryngeal mask airway Exclusion Criteria: Previous cardiac surgery Antihypertensive medication requirement for intravenous anesthetic ASA classification non 1,2 parental refusal of participation parental refusal of block patients requiring intubation

Ages Eligible for Study
-----------------
Minimum Age: 2 Years
Maximum Age: 7 Years

Sexes Eligible for Study
-----------------
Male

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Penile block<br>Patients undergoing procedure with penile block | Procedure: Block performed<br>* Comparing block performed with penile blood flow<br>Device: LMA placement<br>* Placement of LMA for airway securement<br>|
| caudal block<br>Patients undergoing procedure with caudal block | Procedure: Block performed<br>* Comparing block performed with penile blood flow<br>Device: LMA placement<br>* Placement of LMA for airway securement<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| penile blood flow | assessment of changes using ultrasound to blood flow based on block performed | 20 minutes |