Skip to main content
Top
Published in: Pediatric Surgery International 1/2024

01-12-2024 | Circumcision | Original Article

Comparison of the effects of ring block and dorsal penile nerve block on parental satisfaction for circumcision operation in children: randomized controlled trial

Authors: Hatice Toprak, Emre Kandemir

Published in: Pediatric Surgery International | Issue 1/2024

Login to get access

Abstract

Purpose

In children, circumcision is a procedure associated with perioperative pain and parental satisfaction is an important parameter in the evaluation of anesthesia procedures. Inadequate dorsal penile nerve block (DPNB) for the ventral shaft of the penis might impact parental satisfaction negatively. To evaluate this hypothesis, we compared the effects of penile ring block (RB) and dorsal penile nerve block (DPNB) on parental satisfaction. Postoperative pain, need for additional analgesia, intraoperative hemodynamic data, recovery status, side effects, and postoperative complications were evaluated as secondary outcomes between the blocks.

Methods

Parental satisfaction and anesthetic effectiveness of RB and DPNB for circumcision in children were compared. 86 patients were randomized 1:1 to Group RB and Group DPNB, which were administered the same dose of anesthesia. Parental satisfaction was evaluated with the Pediatric Anesthesia Parental Satisfaction Questionnaire (PAPS). Postoperative pain evaluations were made with the Face, Legs, Activity, Crying, Consolability Pain Scale (FLACC).

Results

In terms of parent satisfaction, no differences were detected between the groups in the pre-anesthesia, pre-anesthesia and post-anesthesia, post-anesthesia, hospital team, and anesthesia team parameters (p > 0.05). The scores of Group DPNB patients were higher only in the “Q11” subparameter in the “anesthesia team” parameter, and this difference was significant (0.024).

Conclusion

RB and DPNB were compared in circumcision, which is the most common surgical procedure for children. Parental satisfaction, anesthesia, and analgesic effects of both blocks were found to be similar.

Clinical trials

ACTRN12622001211752.
Literature
2.
go back to reference Milliken-Glabe SJ, Zuk J, Ziniel SI, Bjur KA, Alvarez M, Szolnoki JM et al (2017) First steps in validating the pediatric anesthesia parent satisfaction (PAPS) survey. Paediatr Anaesth 27(2):153–161CrossRefPubMed Milliken-Glabe SJ, Zuk J, Ziniel SI, Bjur KA, Alvarez M, Szolnoki JM et al (2017) First steps in validating the pediatric anesthesia parent satisfaction (PAPS) survey. Paediatr Anaesth 27(2):153–161CrossRefPubMed
3.
go back to reference Morris BJ, Wamai RG, Henebeng EB, Tobian AA, Klausner JD, Banerjee J et al (2016) Estimation of country-specific and global prevalence of male circumcision. Popul Health Metr 1(14):4CrossRef Morris BJ, Wamai RG, Henebeng EB, Tobian AA, Klausner JD, Banerjee J et al (2016) Estimation of country-specific and global prevalence of male circumcision. Popul Health Metr 1(14):4CrossRef
4.
go back to reference Alanis MC, Lucidi RS (2004) Neonatal circumcision: a review of the world’s oldest and most controversial operation. Obstet Gynecol Surv 59(5):379–395CrossRefPubMed Alanis MC, Lucidi RS (2004) Neonatal circumcision: a review of the world’s oldest and most controversial operation. Obstet Gynecol Surv 59(5):379–395CrossRefPubMed
5.
go back to reference Bondesson E, Olofsson T, Caverius U, Schelin MEC, Jöud A (2020) Consultation prevalence among children, adolescents and young adults with pain conditions: a description of age- and gender differences. Eur J Pain 24(3):649–658CrossRefPubMed Bondesson E, Olofsson T, Caverius U, Schelin MEC, Jöud A (2020) Consultation prevalence among children, adolescents and young adults with pain conditions: a description of age- and gender differences. Eur J Pain 24(3):649–658CrossRefPubMed
6.
go back to reference Hicks CL, von Baeyer CL, Spafford PA, van Korlaar I, Goodenough B (2001) The faces pain scale-revised: toward a common metric in pediatric pain measurement. Pain 93(2):173–183CrossRefPubMed Hicks CL, von Baeyer CL, Spafford PA, van Korlaar I, Goodenough B (2001) The faces pain scale-revised: toward a common metric in pediatric pain measurement. Pain 93(2):173–183CrossRefPubMed
7.
go back to reference Polaner DM, Taenzer AH, Walker BJ, Bosenberg A, Krane EJ, Suresh S et al (2012) Pediatric regional anesthesia network (PRAN): a multi-institutional study of the use and incidence of complications of pediatric regional anesthesia. Anesth Analg 115(6):1353CrossRefPubMed Polaner DM, Taenzer AH, Walker BJ, Bosenberg A, Krane EJ, Suresh S et al (2012) Pediatric regional anesthesia network (PRAN): a multi-institutional study of the use and incidence of complications of pediatric regional anesthesia. Anesth Analg 115(6):1353CrossRefPubMed
8.
go back to reference Ecoffey C, Lacroix F, Giaufré E, Orliaguet G, Courrèges P, Française (adarpef) ADARPD (2010) Epidemiology and morbidity of regional anesthesia in children: a follow-up one-year prospective survey of the French-Language Society of Paediatric Anaesthesiologists (ADARPEF). Pediatr Anesth 20(12):1061–1069CrossRef Ecoffey C, Lacroix F, Giaufré E, Orliaguet G, Courrèges P, Française (adarpef) ADARPD (2010) Epidemiology and morbidity of regional anesthesia in children: a follow-up one-year prospective survey of the French-Language Society of Paediatric Anaesthesiologists (ADARPEF). Pediatr Anesth 20(12):1061–1069CrossRef
9.
go back to reference Aksu C, Akay MA, Şen MC, Gürkan Y (2019) Ultrasound-guided dorsal penile nerve block vs neurostimulator-guided pudendal nerve block in children undergoing hypospadias surgery: a prospective, randomized, double-blinded trial. Pediatr Anesth 29(10):1046–1052CrossRef Aksu C, Akay MA, Şen MC, Gürkan Y (2019) Ultrasound-guided dorsal penile nerve block vs neurostimulator-guided pudendal nerve block in children undergoing hypospadias surgery: a prospective, randomized, double-blinded trial. Pediatr Anesth 29(10):1046–1052CrossRef
10.
go back to reference Cote CJ, Lerman J, Todres ID (2012) A practice of anesthesia for ınfants and children E-book: expert consult: Online and Print. Elsevier Health Sciences, p 1660 Cote CJ, Lerman J, Todres ID (2012) A practice of anesthesia for ınfants and children E-book: expert consult: Online and Print. Elsevier Health Sciences, p 1660
11.
go back to reference Naja Z, Al-Tannir MA, Faysal W, Daoud N, Ziade F, El-Rajab M (2011) A comparison of pudendal block vs dorsal penile nerve block for circumcision in children: a randomised controlled trial. Anaesthesia 66(9):802–807CrossRefPubMed Naja Z, Al-Tannir MA, Faysal W, Daoud N, Ziade F, El-Rajab M (2011) A comparison of pudendal block vs dorsal penile nerve block for circumcision in children: a randomised controlled trial. Anaesthesia 66(9):802–807CrossRefPubMed
12.
go back to reference Holliday MA, Pinckert TL, Kiernan SC, Kunos I, Angelus P, Keszler M (1999) Dorsal penile nerve block vs topical placebo for circumcision in low-birth-weight neonates. Arch Pediatr Adolesc Med 153(5):476–480CrossRefPubMed Holliday MA, Pinckert TL, Kiernan SC, Kunos I, Angelus P, Keszler M (1999) Dorsal penile nerve block vs topical placebo for circumcision in low-birth-weight neonates. Arch Pediatr Adolesc Med 153(5):476–480CrossRefPubMed
14.
go back to reference Lander J, Brady-Fryer B, Metcalfe JB, Nazarali S, Muttitt S (1997) Comparison of ring block, dorsal penile nerve block, and topical anesthesia for neonatal circumcision: a randomized controlled trial. JAMA 278(24):2157–2162CrossRefPubMed Lander J, Brady-Fryer B, Metcalfe JB, Nazarali S, Muttitt S (1997) Comparison of ring block, dorsal penile nerve block, and topical anesthesia for neonatal circumcision: a randomized controlled trial. JAMA 278(24):2157–2162CrossRefPubMed
15.
go back to reference Long RM, McCartan D, Cullen I, Harmon D, Flood HD (2010) A preliminary study of the sensory distribution of the penile dorsal and ventral nerves: implications for effective penile block for circumcision. BJU Int 105(11):1576–1578CrossRefPubMed Long RM, McCartan D, Cullen I, Harmon D, Flood HD (2010) A preliminary study of the sensory distribution of the penile dorsal and ventral nerves: implications for effective penile block for circumcision. BJU Int 105(11):1576–1578CrossRefPubMed
16.
go back to reference Ozen V, Yigit D (2020) 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 16(1):99–106CrossRefPubMed Ozen V, Yigit D (2020) 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 16(1):99–106CrossRefPubMed
17.
go back to reference Serour F, Mori J, Barr J (1994) Optimal regional anesthesia for circumcision. Anesth Analg 79(1):129–131CrossRefPubMed Serour F, Mori J, Barr J (1994) Optimal regional anesthesia for circumcision. Anesth Analg 79(1):129–131CrossRefPubMed
18.
go back to reference Tree-Trakarn T, Pirayavaraporn S (1985) Postoperative pain relief for circumcision in children: comparison among morphine, nerve block, and topical analgesia. Anesthesiology 62(4):519–522CrossRefPubMed Tree-Trakarn T, Pirayavaraporn S (1985) Postoperative pain relief for circumcision in children: comparison among morphine, nerve block, and topical analgesia. Anesthesiology 62(4):519–522CrossRefPubMed
19.
go back to reference Karasu D, Yilmaz C, Ozgunay SE, Karaduman I, Ozer D, Kaya M (2018) Effects of different anesthetic agents on surgical site hemorrhage during circumcision. Urol J 15(2):21–26PubMed Karasu D, Yilmaz C, Ozgunay SE, Karaduman I, Ozer D, Kaya M (2018) Effects of different anesthetic agents on surgical site hemorrhage during circumcision. Urol J 15(2):21–26PubMed
20.
go back to reference Brown TCK, Weidner NJ, Bouwmeester J (1989) Dorsal nerve of penis block—anatomical and radiological studies. Anaesth Intensive Care 17(1):34–38CrossRefPubMed Brown TCK, Weidner NJ, Bouwmeester J (1989) Dorsal nerve of penis block—anatomical and radiological studies. Anaesth Intensive Care 17(1):34–38CrossRefPubMed
21.
go back to reference Sandeman DJ, Dilley AV (2007) Ultrasound guided dorsal penile nerve block in children. Anaesth Intensive Care 35(2):266–269CrossRefPubMed Sandeman DJ, Dilley AV (2007) Ultrasound guided dorsal penile nerve block in children. Anaesth Intensive Care 35(2):266–269CrossRefPubMed
22.
go back to reference Hardwick-Smith S, Mastrobattista JM, Wallace PA, Ritchey ML (1998) Ring block for neonatal circumcision. Obstet Gynecol 91(6):930–934PubMed Hardwick-Smith S, Mastrobattista JM, Wallace PA, Ritchey ML (1998) Ring block for neonatal circumcision. Obstet Gynecol 91(6):930–934PubMed
23.
go back to reference Naja ZA, Ziade FM, Al-Tannir MA, Abi Mansour RM, El-Rajab MA (2005) Addition of clonidine and fentanyl: comparison between three different regional anesthetic techniques in circumcision. Paediatr Anaesth 15(11):964–970CrossRefPubMed Naja ZA, Ziade FM, Al-Tannir MA, Abi Mansour RM, El-Rajab MA (2005) Addition of clonidine and fentanyl: comparison between three different regional anesthetic techniques in circumcision. Paediatr Anaesth 15(11):964–970CrossRefPubMed
24.
go back to reference Osmani F, Ferrer F, Barnett NR (2021) Regional anesthesia for ambulatory pediatric penoscrotal procedures. J Pediatr Urol 17(6):836–844CrossRefPubMed Osmani F, Ferrer F, Barnett NR (2021) Regional anesthesia for ambulatory pediatric penoscrotal procedures. J Pediatr Urol 17(6):836–844CrossRefPubMed
26.
go back to reference Merkel SI, Voepel-Lewis T, Shayevitz JR, Malviya S (1997) The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr Nurs 23(3):293–297PubMed Merkel SI, Voepel-Lewis T, Shayevitz JR, Malviya S (1997) The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr Nurs 23(3):293–297PubMed
27.
go back to reference Peng T, Qu S, Du Z, Chen Z, Xiao T, Chen R (2023) A systematic review of the measurement properties of face, legs, activity, cry and consolability scale for pediatric pain assessment. J Pain Res 16:1185CrossRefPubMedPubMedCentral Peng T, Qu S, Du Z, Chen Z, Xiao T, Chen R (2023) A systematic review of the measurement properties of face, legs, activity, cry and consolability scale for pediatric pain assessment. J Pain Res 16:1185CrossRefPubMedPubMedCentral
28.
go back to reference Lönnqvist PA (2010) Regional anaesthesia and analgesia in the neonate. Best Pract Res Clin Anaesthesiol 24(3):309–321CrossRefPubMed Lönnqvist PA (2010) Regional anaesthesia and analgesia in the neonate. Best Pract Res Clin Anaesthesiol 24(3):309–321CrossRefPubMed
29.
go back to reference Mellon RD, Simone AF, Rappaport BA (2007) Use of anesthetic agents in neonates and young children. Anesth Analg 104(3):509–520CrossRefPubMed Mellon RD, Simone AF, Rappaport BA (2007) Use of anesthetic agents in neonates and young children. Anesth Analg 104(3):509–520CrossRefPubMed
Metadata
Title
Comparison of the effects of ring block and dorsal penile nerve block on parental satisfaction for circumcision operation in children: randomized controlled trial
Authors
Hatice Toprak
Emre Kandemir
Publication date
01-12-2024
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Surgery International / Issue 1/2024
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI
https://doi.org/10.1007/s00383-024-05681-5

Other articles of this Issue 1/2024

Pediatric Surgery International 1/2024 Go to the issue