Dorsal penile nerve block versus caudal block for circumcision in pediatric patients: A systematic review and meta-analysis

Background

The efficacy of dorsal penile nerve block versus caudal block among children undergoing circumcision has been studied in several trials with conflicting results. We aimed to perform an updated systematic review and meta-analysis comparing both techniques in children undergoing circumcision under general anesthesia.

Methods

MEDLINE, Embase, and Cochrane Library were systematically searched for studies comparing dorsal penile nerve block versus caudal block in children undergoing circumcision. We computed mean differences (MD) or standardized mean difference (SMD) for continuous outcomes and risk ratios (RR) for binary outcomes, with 95 % confidence intervals (CIs). Heterogeneity was assessed using I² statistics. Statistical analyses were performed using R Software, version 4.2.3.

Results

We included 14 studies, comprising 1425 participants, of whom 645 (45.3 %) underwent dorsal penile nerve block. There were no significant differences between groups in time to first analgesic requirement (MD -14.79 min; 95 % CI -59.42 to 29.83; p = 0.52), and postoperative pain at 1h (SMD 0.10; 95 % CI -0.60 to 0.79; p = 0.79), 3h (SMD 0.00; 95 % CI -0.98 to 0.99; p = 0.99), and 24h (SMD 0.30; 95 % CI -2.57 to 3.17; p = 0.84). Dorsal penile nerve block was associated with a shorter time to first walk (MD -30.28 min; 95 % CI -44.50 to −16.05; p < 0.01) and length of hospital stay (MD -28.61 min; 95 % CI -42.13 to −15.10; p < 0.01).

Conclusions

In children undergoing circumcision, dorsal penile nerve block and caudal block had similar times to first rescue analgesic and postoperative pain scores within 24h, although dorsal penile nerve block was associated with a shorter time to first walk and length of hospital stay.