Single-injection penile block versus caudal block in penile pediatric surgery

Background Penile block is recommended for analgesia during and after surface operation on the penis, for example circumcision, phimosis, meatal stenosis, and hypospadias repair. Objective To evaluate the effect of penile block versus caudal block using bupivacaine on the quality of analgesia, and the surgeon’s and parents’ satisfaction after penile pediatric surgery. Patients and methods This study was conducted on 80 healthy boys aged 1–7 years, of American Society of Anesthesiologists (ASA) I and II health classes, scheduled for hypospadias repair, circumcision and meatal stenosis under general anesthesia. The patients were randomly divided into two equal groups: group P (penile block, 0.25% bupivacaine, 0.5 mg / kg; n = 40) and group C (caudal block, 0.25% bupivacaine, 0.5 mg / kg; n = 40). The heart rate (HR), the mean arterial blood pressure (MAP) and oxygen saturation were measured perioperatively. Postoperative pain evaluated by the FLACC pain scale of fi ve categories, (F) Face, (L) Leg, (A) Activity, (C) Cry, (C) Consolability, was assessed on admission to and on discharge from the PACU and 2, 4, 8, 12, 16 and 24 h postoperatively. Also, the time to fi rst rescue analgesic request and doses of analgesic requirements were recorded. The surgeon’s and parents’ satisfaction were evaluated on the fi rst day of the operation using a fi ve-point verbal score. Results In group P, there was no signifi cant decrease in the HR and the MAP compared with the baseline, but in group C, there was a signifi cant decrease in HR and MAP compared with the baseline. FLACC pain scores were signifi cantly lower in group P compared with group C (P < 0.05). Also, the time to fi rst need for analgesia was signifi cantly (P < 0.05) lower in group P compared with group C. The total analgesic requirement was also signifi cantly lower (P < 0.05) in group P compared with group C. Conclusion Single-injection penile block is superior to caudal epidural block for relief of postoperative pain in children undergoing penile surgery with more satisfaction to the surgeon and the parents, without signifi cant increase in the rate of adverse events.