López-Maya L, Lina-Manjarrez F, Fuentes-Ramos F, Espíndola-Flores BF, Lina-López LM

Language: Spanish
References: 26
Page: 239-246
PDF size: 132.28 Kb.

ABSTRACT

Objective: We performed circumcision in boys under general anesthesia (GA) versus sedation and penile dorsal nerve block (PDNB) to assess the efficacy and safety of this anesthetic technique. The purpose of this study was to determine the benefits of sedation and PDNB as the single PDNB against the GA to perform circumcision in boys in outpatient surgery. Methods: In a comparative, longitudinal, and prospective study conducted in the period June 2006 to June 2008, 164 children aged 1 to 14 years were studied. In total, 2 groups were included. Group 1 (n = 82) received sedation and PDNB for circumcision, and Group 2 (n = 82) received GA. The age, weight, analgesia, pain, surgical time, time in the operating theater, time in the recovery room, and complications from anesthetic procedure were compared in both groups. Results: The average age was 4.6 ± 3.1 years, and average weight was 19.9 ± 10.7 kg in both groups. There were no major surgical complications in the 2 groups. Minor complications included one haematoma which occurred in one boy in Group 1 (1.2%) and no boy in Group 2. Moreover, 2 complications of laryngospasm were observed in the Group 1 compared with 4 complications in Group 2. The average time of surgery was 25.34 ± 10.53 min in Group 1 and 24.02 ± 10.87 min in Group 2 (p ± 0.05). The average operating room use was 58.11 ± 15.68 minutes in Group 1 compared with 63.95 ± 19.32 min in Group 2 (p ‹ 0.05). Time in the Post Anesthesia Care Unit (PACU) was 82.86 ± 21.05 min in Group 1 and 124.26 ± 23.21 in Group 2 (p ‹ 0.05). There is no pain in any patient in Group 1 and it was observed in 15 patients in Group 2 (18.29%). Conclusions: These data support that the PDNB had advantages over the GA for circumcision in pediatric outpatient surgery.

REFERENCES

1. TCK Brown. Local and regional anaesthesia in children. Br J Anaesth 1999;83:65-77.

2. Samy Abdel M. Dorsal penile nerve block versus caudal epidural block for postoperative analgesia in children undergoing distal penile surgery. J Eur Surg 2001;19:71-78.

3. Choi WY. EMLA cream versus dorsal penile nerve block for postcircumcision analgesia in children. Anesth Analg 2003;96:396-99.

4. Serour F. Dorsal penile nerve block in children undergoing circumcision in a day-care surgery. Can J Anaesth 1996;43:954-8.

5. Taddio A. Combined analgesia and local anesthesia to minimize pain during circumcision. Arch Pediatr Adolesc Med 2000;154:620-23.

6. Rodríguez VI. Anestesia tópica con y sin midazolam oral en la circumcision neonatal: comparación con el bloqueo del nervio dorsal del pene. Rev Mex Ped 2006;73:263-67.

7. Valenzuela GL. Comparación entre EMLA versus el bloqueo del nervio dorsal del pene en la circumcision neonatal. Medicina Universitaria www.revistas medicas mexicanas.com.mx 2006;8: 32-38.

8. Berde CB. Local anaesthetics in infants and children an update. Paediatr Anasth 2004;14:387-93.

9. Bosenberg A. Pediatric regional anesthesia update. Paediatr Anest 2004;14:398-402.

10. Lönnqvist PA. Postoperative analgesia in infants and children. Br J Anaesth 2005;95:50-60.

11. Melman SE. Anestesia regional en Pediatría. PAC Anestesia-2. 2000;6:50-55.

12. Soliman MG. Nerve block of the penis for postoperative pain relief in children. Anesth Analg 1978;57:495-98.

13. Vaneuville DB. Penile block via the subpubic space in 100 children. Anesth Analg 1989;69:41-5.

14. Serour F. Circumcision in children with penile block alone. J Urol 1995;153:474-81.

15. Moyao D. Dolor postoperatorio en el paciente pediátrico. Rev Mex Anest 2004;27:138-51.

16. Markakis DA. Anestesia regional en pediatría. Ed. Interamericana. México, D.F. Clin Anest North Am 2000:357-9.

17. Yuon Chi Lin. Anestesia regional y tratamiento del dolor en pacientes pediátricos ambulatorios. Ed. Interamericana. México. D.F. Clin Anest Nort Am 1996:769-71.

18. Santhanan S. Anestesia pediátrica regional práctica. Clin Anest North Am. Ed. Interamericana. México. D.F. 2002:98.

19. Raafats H. Anestesia regional. Ed. Interamericana Clin Anest Nort Am México. D.F. 1991:903-4.

20. Morten NS. Postoperative analgesia in infants and children. Br J Anaesth 2005:95.

21. Stolik OC. Bupivacaine versus lidocaine analgesia for neonatal circumcision. BMJ Ped 2005;5:12.

22. Masaciello AL. Anestesia for neonatal circumcision: local anesthesia is better than dorsal penile nerve block. Anaesthesist 1998;37:636-41.

23. Corona FJ. Elementos de estadística, aplicaciones al método experimental. Ed. Trillas México. D. F. 1994:22-47.

24. Castañeda JJ. Metodología de la Investigación. Ed. McGraw-Hill México. D.F. 2005:141-159.

25. Gómez AD. Cómo escribir y publicar un artículo científico. Ed. Nieto México, D.F. 2007:49-74.

26. Sánchez PTL. Guía metodológica para la elaboración de un protocolo de investigación en el área de salud. Ed. Prado. México D.F. 2002:89-123.