Comparative Evaluation of Pudendal versus Dorsal Penile Nerve Block for Analgesia in Pediatric Circumcision: A Randomized Controlled Study

Introduction: Topical analgesics, caudal block, and ring block of the penis are a few examples of regional anesthesia that have been utilized during circumcision and have varying degrees of effectiveness. Transient motor block has been linked to caudal block. The dorsal penile nerve block is a successful anesthetic technique, with extended postoperative analgesia, according to earlier investigations. However, it has a 4-6.7% failure rate that has been documented. To compare the analgesic and anesthetic efficacy of bilateral nerve stimulator-guided pudendal nerve block with that of dorsal nerve block for perioperative and postoperative analgesia in children undergoing circumcision, we conducted a prospective randomized controlled clinical trial based on this background Methods: A prospective, single-blinded, randomized investigation was carried out from March 2020 to February 2025 with the approval of the institutional review board and the signed agreement of the parents. 50 ASA-1 male children between the ages of 3 and 5 who were scheduled for elective circumcision were included in the study. A pre-existing coagulopathy, an infection at the injection site, and a known allergy to local anesthetic were among the exclusion criteria. One group received a pudendal nerve block, while the other group received a dorsal nerve block. For the first day, pain ratings were taken at various intervals (0, 6 and 12 h, and once per day for the next 5 days). It was measured using the Objective Pain Scale as modified by Hannallah et al. Result: Age, hemodynamic stability, and duration of surgery were comparable across the two groups (Table 1). In the group of patients who had their pudendal nerves blocked, every patient underwent circumcision as planned without requiring any analgesics. 3 patients (12%) in the dorsal nerve block group experienced an incomplete block, necessitating further local infiltration. In the dorsal nerve block group, one patient (4%) had total block failure and underwent general anesthesia (Table 2). In conclusion, as compared to the dorsal nerve block, the guided pudendal nerve block method has been shown to be more precise and successful in circumcising children.