Comparison of Dorsal Penile Nerve Block and Laryngeal Mask Applications for the Management of Circumcision Surgery

Year 2022, , 345 - 349, 01.08.2022

Öznur Uludag , Mehmet Duran , Ebru Dumlupınar , Öğünç Apaydın , Musa Abeş

https://doi.org/10.54005/geneltip.1115842

Cited By: 1

Abstract

Objective: Circumcision is the excision and removal of skin part that covers glans penis which is called as prepicium, Dorsal penile nevre block (DPNB) is used alone or in combination with general anesthesia for circumcision. Application of a laryngeal mask (LMA) is preferred especially in pediatric age group because it requiresless anesthetic substance, it doesn’t trigger laryngeal reflexes. Our aim was to compare DPNB application under sedation and LMA application for management of anesthesia in circumcision surgery.
Material and Methods: The thousand and ten patients who had DPNB under sedation and LMA were compared with regards to duration of surgery, duration of anesthesia, duration of recovery, need for postoperative analgesia, complications, and season of surgery.
Results: Duration of surgery, anesthesia, and recovery were significantly shorter in DPNB application under sedation compared with LMA application (p<0,05). For postoperative analgesia caudal block was applied to 72, and IV analgesics were applied to 433 patients who had LMA application. DPNB provided sufficient analgesia.
Conclusion: Application of DPNB under sedation provides both adequate anesthesia and postoperative pain control by allowing less surgery, anesthesia, and recovery durations than LMA application.

Keywords

Circumcision Surgery, Dorsal penile nevre block, Laryngeal mask

References

• 1. American Academy of Pediatrics Task Force on Circumcision. Circumcision policy statement. Pediatrics 2012; 130: 585-586.
• 2. August DA Everett LL. Pediatric ambulatory anesthesia. Anesthesiol Clin 2014; 32: 411-429.
• 3. Bellieni CV, Alagna MG, Buonocore G. Analgesia for infants’ circumcision. Ital J Pediatr. BioMed Central; 2013; 39: 38.
• 4. Beyaz SG. Comparison of postoperative analgesic efficacy of caudal block versus dorsal penile nerve block with levobupivacaine for circumcision in children. Korean J Pain 2011; 24: 31‐35.
• 5. Polaner DM, Taenzer AH, Walker BJ, et al. Pediatric Regional Anesthesia Network (PRAN): a multi-institutional study of the use and incidence of complications of pediatric regional anesthesia. AnesthAnalg 2012; 115: 1353-1364.
• 6. Mancuso T, Burns J. Ethical concerns in the management of pain in the neonate. PediatrAnesth 2009; 19: 953–957.
• 7. Sabuncu U, Kusderci HS, Oterkus M, Abdullayev R, Demir A, Uludag O, Ozdas S, Goksu M. AuraGain and i-Gel laryngeal masks in general anesthesia for laparoscopic cholecystectomy. Performance characteristics and effects on hemodynamics. Saudi Med J 2018; 39(11): 1082-1089. doi: 10.15537/smj.2018.11.22346
• 8. Pennant J, White P. The laryngeal mask airway: Its usesing anesthesiology. Anaesthesiology 1993; 79: 144. 9. Bateman DV. Correspondence. Anaesthesia 1975;30: 101.
• 10. Soh CR, Ng SBA, Lim SL. Dorsal penile nerve block. PaediatrAnaesth 2003; 13: 329-333.
• 11. Soliman MG, Tremblay NA. Nerve block of the penis for postoperative pain relief in children. Anesth Analg 1978; 57: 495–498.
• 12. Berde CB. Toxicity of local anesthetics in infants and children. J Pediatr 1993; 122: 14-20.
• 13. Choi WY, Irwin MG, Lim, Chan KL. EMLA! Cream versus dorsal penile nerve block for postcircumcision analgesia in children. AnesthAnalg 2003; 96: 396-399.
• 14. Jagannathan N, Ramsey MA, White MC, Sohn L. An update on newer pediatric supraglottic airways with recommendations for clinical use. PaediatrAnaesth 2015; 25: 334-345.
• 15. Altaş C, Küçükosman G, Yurtlu B, et al. Anesthesia methods used by anesthetic specialists for circumcision cases National survey study for Turkey. Saudi Med J 2017; 38: 75-81.
• 16. Serour F, Cohen A, Mandelberg A, Mori J, Ezra S. Dorsal penile nerve block in children undergoing circumcision in a day-care surgery. Can J Anaesth 1996; 43: 954-958.
• 17. Cyna AM, Middleton P. Caudal epidural block versus other methods of postoperative pain relief for circumcision in boys. Cochrane Database Syst Rev 2008; 8: CD003005.
• 18. Haliloglu AH, Gokce MI, Tangal S, Boga MS, Tapar H, Aladag E. Comparison of postoperative analgesic efficacy of penile block, caudal block and intravenous paracetamol for circumcision: a prospective randomized study. Int Braz J Urol 2013; 39: 551-557.
• 19. Faraoni D, Gilbeau A, Lingier P, Barvais L, Engelman E, Hennart D. Does ultrasound guidance improve the efficacy of dorsal penile nerve block in children? PaediatrAnaesth 2010; 10: 931-936.
• 20. Masciello AL. Anesthesia for neonatal circumcision: Local anesthesia is better than dorsal penile nerve block. Obst Gynec 1990; 75: 834-838.
• 21. Stang HJ, Gunnar MR, Snellman L, Condon LM, Kstenbaum R. Local anaesthetic for neonatal circumcision. Effects on distress and cortisol response. JAMA 1988; 259: 1507–1511.
• 22. Serour F, Reuben S, Ezra S. Circumcision in children with penile block alone. J Urol 1995; 153: 474-476.
• 23. Ozen V, Yigit D. A comparison of the postoperative analgesic effectiveness of low dose caudal epidural block and US-guided dorsal penile nerve block with in-plane technique in circumcision. J Pediatr Urol 2019; S1477-5131(19)30340-7. doi: 10.1016/j.jpurol.2019.10.020.
• 24. Allan CY, Jacqueline PA, Shubhda JH. Caudal epidural block versus other methods of postoperative pain relief for circumcision in boys. Cochrane Database Syst Rev 2003; 2: 2-8.
• 25. Brasher C, Gafsous B, Dugue S, et al. Postoperative Pain Management in Children and Infants: An Update. Pediatr Drugs 201416: 129–140.
• 26. Gauntlett I. A comparison between local anaesthetic dorsal nerve block and caudal bupivacaine with ketamine for paediatric circumcision. PaediatrAnaesth 200313: 38-42.
• 27. Panda A, Bajwa SJS, Sen S, Parmar SS. Penile block for paediatric urological surgery: A comparative evaluation with general anaesthesia. Indian J Urol 2011; 27: 457-464.
• 28. O'Sullivan MJ, Mislovic B, Alexander E. Dorsal penile nerve block for male pediatric circumcision--randomized comparison of ultrasound-guided vs anatomical landmark technique. PaediatrAnaesth 2011; 21: 1214-1218. doi: 10.1111/j.1460-9592.2011.03722.x.