Levobupivacaine for Postoperative Pain Management in Circumcision; Caudal Blocks or Dorsal Penile Nerve Block

Purpose: In this study, we evaluated the analgesic efficacy and adverse effect profile of levobupivacaine in caudal and DPNB in postcircumcision pediatric patients.
Methods: Sixty boys between 2-10 age undergoing circumcision were enrolled. The patients were divided into two groups; Group C (n=30) and Group P (n=30) were applied caudal block and dorsal penile nerve block (DPNB), respectively. Blocks were performed before surgery as a supplement to general anesthesia with 1 mL kg-1 0.25% levobupivacaine. Postoperative pain and sedation scores were assessed on the 10th, 30th minutes, 1th, 2 th, 3 th, 4 th, 5 th and 6th hours. The number of pain free patients for the first 6 hours, duration of analgesia, time to first analgesic administration, walking, micturition, and total paracetamol demands, and length of stay were recorded.
Results: Demographic data were similar between groups. The number of children who spent the first 6 hours pain free was larger in Group C than Group P (p=0.0001). The time to first analgesic (p=0.000033) and walking (p=0,004) were longer in Group C. There were 14 patients with motor block in Group C (p=0.00007). In view of AUC; FPRS, OPS and MPOPS were significantly better in Group C on the first postoperative 6 hours.
Conclusion: Caudal block done by using levobupivacaine for postoperative pain management in circumcision is more successful than penile block; however there is a significant delay in time to first walking and as might be expected there is a risk for motor block.