European Journal of Molecular & Clinical Medicine

Introduction: Circumcision is a painful procedure in children for which various methods are being used for pain relief. The aim of this study was to compare caudal block and penile block using ropivacaine for post-operative analgesia in paediatric patient posted for circumcision.
Methods and Materials: It was a prospective, randomised, double blinded study over a period of 6 months in 40 male patients, age between 1-7 years. The patients were divided in to two groups 20 each. GROUP C received caudal block with 0.2ml/kg of 0.25% ropivacaine by 23-G 1½ needle through sacral hiatus. GROUP P received penile block with 0.2ml/kg of 0.25% ropivacaine by 23G needle. The postoperative pain was evaluated by FLACC (Face, Legs, Activity, Crying and Consolability) pain Scale. The patient's Postoperative pain was recorded using emergence numerical pain score on a scale of 0-10: The Facial expression, Leg activity, Crying and Consolability and on Visual Analogue Scale (VAS) score.
Results: We found that the mean pulse rate in Group C was less than Group P which was statistically significant at 4, 8, 24 hours. But the changes were not clinically significant. It was found that the mean VAS Scores were on lower side in Group C when compared to Group P. The mean VAS Score ranged from 2.5 to 4.75 in Group C and 3.4 to 5.45 in Group P.
Conclusion: We have demonstrated that although penile block is a safe and effective method of providing post-circumcision analgesia, Caudal block is superior in terms of its reliability, prolonged duration of action and in reducing post-operative pain score.

Caudal block can be performed as a single shot caudal or a continuous caudal using catheter
techniques. Single shot caudal blocks are used for ambulatory and minor procedures while continuous
catheter techniques are used for in-patients undergoing more extensive procedures. This study included
72 children, of both genders, coming for various elective infra-umbilical surgical procedures such as
herniotomy, orchidopexy, circumcision etc. Ethical clearance from institutional ethical committee was
obtained. Informed consent was obtained from the parents before including the children in the study. In
group A, the mean baseline heart rate was 122.67±9.08 per min which decreased to112.97±8.70 at 5
mins. The heart rate gradually decreased to 93.03±5.33 per min at 30 mins and 90.43±5.80 at 60 mins.
The mean baseline heart rate in group Bwas 121.92±8.52 per min which decreased to 112.19±9.79 at 5
mins and gradually decreased to 90.17±6.96 at 30 mins and 90.82±5.53 at 60 mins. However, there was
no significant difference in the heart rate between the two groups at any time interval.

The benefits of regional anaesthesia in children are well documented. These include attenuation of the
stress response, reduced opioid requirement and therefore reduction in associated side effects,
improved postoperative analgesia, and earlier extubation. Caudal epidural block is one of the most
common regional techniques in paediatric anesthesia. Caudal block is safe and reliable technique, easy
to perform and has been found to be very effective in children, especially in infra-umbilical surgeries
when combined with general anaesthesia. This study included 72 children, of both genders, coming for
various elective infra-umbilical surgical procedures such as herniotomy, orchidopexy, circumcision etc.
Ethical clearance from institutional ethical committee was obtained. Informed consent was obtained
from the parents before including the children in the study. Optimal calculated needle angle for
successful caudal block was 28.14±4.03 degrees in Group A, 19.22±2.78 degrees in Group B, which
was statistically significant. Needling time or procedural time for successful caudal block was
5.97±1.32 seconds in Group A, 14.25±2.93 seconds in Group B, which was statistically significant.