Is penile block better than caudal epidural block for postcircumcision analgesia?

PURPOSE: To compare caudal and penile block for post-operative analgesia in children undergoing circumcision with respect to efficacy, complication rates, and parental satisfaction.

METHODS: The study population consisted of 100 ASA 1 and 2 boys aged 3 to 8 years who were undergoing circumcision for religious reasons. In all participants, inhalation anesthesia was administered with oxygen : nitrous oxide (1 : 2) and halothane. The participants were allocated randomly into two groups of 50 children each. Group 1 received penile block and Group 2 caudal block. The penile block was achieved by injecting bupivacaine into the two compartments of the subpubic space, with an additional ventral infiltration of a small volume of bupivacaine along the raphe of the penis. For caudal block, 1 ml.kg(-1) body weight of 0.25% bupivacaine was administered.

RESULTS: Penile block shortened the induction-incision time and enabled earlier discharge home compared with caudal block. One patient undergoing penile block and nine patients undergoing caudal block vomited.

CONCLUSIONS: Penile and caudal block are equally effective for postcircumcision analgesia and neither is associated with serious complications. Anesthesiologist preference should be the deciding factor in choosing one technique over the other.