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A comparison of caudal bupivacaine and ketamine with penile block for paediatric circumcision

Published online by Cambridge University Press:  01 December 2008

L. Margetts ,
A. Carr ,
G. McFadyen  and
A. Lambert
L. Margetts
Affiliation:
Derriford Hospital, Directorate of Anaesthesia, Theatres and Pain Services, Plymouth, UK
A. Carr*
Affiliation:
Derriford Hospital, Directorate of Anaesthesia, Theatres and Pain Services, Plymouth, UK
G. McFadyen
Affiliation:
Morriston Hospital, Directorate of Anaesthesia, Swansea, UK
A. Lambert
Affiliation:
Derriford Hospital, Directorate of Surgery, Plymouth, UK
*
Correspondence to: Alison Carr, South West Peninsula Postgraduate Deanery, The John Bull Building, Tamar Science Park, Research Way, Plymouth PL6 8DH, UK. E-mail: [email protected]; Tel: +44 175 243 7430; Fax: +44 175 251 7858
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Summary

Background and objectives

To establish whether caudal with ketamine or penile block provide superior postoperative analgesia for paediatric circumcision.

Method

This was a single centre, prospective, randomized, controlled, double-blind trial. Forty males (aged between 18 months and 16 yr) were randomized to receive either a penile block using 0.25 mL kg−1 0.5% bupivacaine (Group P), or a caudal block using 0.5 mL kg−1 0.25% bupivacaine with 0.5 mg kg−1 ketamine (Group C). All of them were given a standard anaesthetic and rectal paracetamol 40 mg kg−1 and diclofenac 1–1.5 mg kg−1. Postoperative pain scores were assessed in recovery and the time to first analgesia, micturition and walking were recorded.

Results

There were no failures in either group. The time to first analgesia was longer in Group C (C median = 459 min, interquartile range 374–553 min; P median = 374 min, interquartile range 224–507 min; P < 0.05). There was a delay in time to walking in Group C (C median = 162 min, interquartile range 119–208 min; P median = 120 min, interquartile range 92–132 min; P < 0.05). There was no difference between the groups in time to waking or micturition, or the incidence of vomiting, abnormal behaviour or bleeding.

Conclusion

Caudal bupivacaine with ketamine and penile block both provide effective postoperative analgesia for circumcision when given with non-steroidal anti-inflammatory drugs. This study shows that caudal bupivacaine with ketamine provides a longer duration of analgesia than penile block, but also causes delay in walking.

Keywords

ANALGESIA POSTOPERATIVECHILDANAESTHETICS LOCALBUPIVACAINEANAESTHESIA CAUDALANAESTHESIA EPIDURALKETAMINE
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 12 , December 2008 , pp. 1009 - 1013
Copyright
Copyright © European Society of Anaesthesiology 2008

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References

1.Lunn, JN. Postoperative analgesia after circumcision. Anaesthesia 1979; 34: 552–554.CrossRefGoogle ScholarPubMed
2.Irwin, MG, Cheng, W. Comparison of subcutaneous ring block of the penis with caudal epidural for post-circumcision analgesia in children. Anaesth Intensive Care 1996; 24: 365–367.CrossRefGoogle ScholarPubMed
3.Vater, M, Wandless, J. Caudal or dorsal nerve block? A comparison of two local anaesthetic techniques for postoperative analgesia following day case circumcision. Acta Anaesthesiol Scand 1985; 29: 175–179.CrossRefGoogle ScholarPubMed
4.Yeoman, PM, Cooke, R, Hain, WR. Penile block for circumcision? A comparison with caudal blockade. Anaesthesia 1983; 38: 862–866.CrossRefGoogle ScholarPubMed
5.Holder, KJ, Peutrell, JM, Weir, PM. Regional anaesthesia for circumcision. Subcutaneous ring block of the penis and subpubic penile block compared. Eur J Anaesthesiol 1997; 14: 495–498.CrossRefGoogle ScholarPubMed
6.Wolf, AR. Tears at bedtime: a pitfall of extending paediatric day-case surgery without extending analgesia. Br J Anaesth 1999; 82: 319–320.CrossRefGoogle ScholarPubMed
7.Sanders, JC. Paediatric regional anaesthesia, a survey of practice in the United Kingdom. Br J Anaesth 2002; 89: 707–710.CrossRefGoogle ScholarPubMed
8.Naguib, M, Sharif, AMY, Seraj, M, El Gammal, M, Dawlatly, AA. Ketamine for caudal analgesia in children: comparison with caudal bupivacaine. Br J Anaesth 1991; 67: 559–564.CrossRefGoogle ScholarPubMed
9.Cook, B, Grubb, DJ, Aldridge, LA, Doyle, E. Comparison of the effects of adrenaline, clonidine and ketamine on the duration of caudal analgesia produced by bupivacaine in children. Br J Anaesth 1995; 75: 698–701.CrossRefGoogle ScholarPubMed
10.Gadiyar, V, Gallagher, TM, Crean, PM, Taylor, R. The effect of a combination of rectal diclofenac and caudal bupivacaine on postoperative analgesia in children. Anaesthesia 1995; 50: 820–822.CrossRefGoogle ScholarPubMed
11.Gauntlett, I. A comparison between local anaesthetic dorsal nerve block and caudal bupivacaine with ketamine for paediatric circumcision. Paediatr Anaesth 2003; 13: 38–42.CrossRefGoogle ScholarPubMed
12.Hicks, C, von Baeyer, CL, Spafford, PA, van Korlaar, I, Goodenough, B. The faces pain scale-revised: toward a common metric in paediatric pain measurement. Pain 2001; 93: 172–183.CrossRefGoogle Scholar
13.Johnstone, P, Findlow, D, Aldridge, LM, Doyle, E. The effect of ketamine on 0.25% and 0.125% bupivacaine for caudal blockade in children. Paed Anaesth 1999; 9: 31–34.CrossRefGoogle Scholar
14.Wolf, AR, Valley, RD, Fear, DW, Roy, WL, Lerman, J. L-Bupivacaine for caudal anaesthesia in infants and children: the optimal effective concentration. Anaesthesiology 1988; 69: 102–106.CrossRefGoogle Scholar
15.Bramwell, RGB, Bullen, C, Radford, P. Caudal block for postoperative analgesia in children. Anaesthesia 1982; 37: 1024–1028.CrossRefGoogle ScholarPubMed
16.Koinig, H, Marhofer, P, Krenn, CG et al. Analgesic effects of caudal and intramuscular S(+)-Ketamine in children. Anaesthesiology 2000; 93: 976–980.CrossRefGoogle ScholarPubMed
17.Marhofer, P, Krenn, CG, Plochl, W et al. S(+)-Ketamine for caudal block in paediatric anaesthesia. Br J Anaesth 2000; 84: 341–345.CrossRefGoogle ScholarPubMed
18.Semple, D, Findlow, D, Aldridge, LM, Doyle, E. The optimal dose of ketamine for caudal epidural blockade in children. Anaesthesia 1996; 51: 1170–1172.CrossRefGoogle ScholarPubMed
19. Cyna A, Parsons J, Jha S. Caudal epidural block versus other methods of postoperative pain relief for circumcision in boys (Cochrane Review) The Cochrane Library, 2004, Issue 3, CD003005.CrossRefGoogle Scholar