Comparison between the Caudal Block and Other Methods of Postoperative Pain Relief in Children Undergoing Circumcision: A Prospective Randomized Study

Author(s): Zeana A. Gawe, Hasan M. Isa, Zania Abdulsattar, Fayza Haider, Enjy E. Khedr, Eslam M. Khalifa

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.