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Caudal and penile blocks Demonstrate Similar Reliability and Efficacy in Pediatric Patients Undergoing Circumcision: A Meta-Analysis

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International Journal of Clinical Medicine 2016年第5期7卷 309-319页

作者： Kiran Malik Ronald S. Chamberlain Saint George’s University School of Medicine Grenada West Indies Department of Surgery Saint Barnabas Medical Center Livingston USA Department of Surgery New Jersey Medical School Rutgers University Newark USA

Purpose: Circumcision is one of the most common surgeries performed in the pediatric population. Multiple regional analgesic techniques, including caudal (CB) and penile block (PB), have championed as offering optimal analgesia for circumcision in the post-neonatal pediatric population without clear consensus. This meta-analysis sought to investigate CB and PB’s analgesic efficacy and the impact on postoperative analgesic requirements in pediatric circumcisions. Methods: A comprehensive literature search of PubMed, Google Scholar, and Cochrane Library (1966-2016) was completed to identify all published randomized control trials (RCTs). Keywords searched included “circumcision”, “caudal block”, “penile block”, and “analgesia”. Inclusion criteria were limited to the comparison of PB versus CB in children less than 18 years of age and its efficacy towards circumcision. The efficacy, time to first additive analgesia, time to first micturition, duration of prolonged motor blockade, incidence of vomiting, and length of stay were analyzed. Results: 9 RCTs involving 574 children (N = 287 in CB and PB) were included. No differences in analgesic efficacy (relative risk (RR) = 0.983, 95% confidence interval (CI) = 0.95 to 1.02;p = 0.328) or time to first additive analgesia were observed (standardized difference in mean (SDM) = 0.438, 95% CI = -0.04 to 0.92;p = 0.073). Time to first micturition (SDM = 0.680, 95% CI = 0.40 to 0.96;p p = 0.007) were significantly prolonged in patients receiving CB. No differences were observed between groups in regards to the incidence of vomiting (RR = 1.56, 95% CI = 0.91 to 2.67;p = 0.107) and length of stay (SDM = 0.741, 95% CI = -0.05 to 1.53;p = 0.066). Conclusion: CB and PB offer similar analgesic success rates for pediatric patients (age 18 months to 16 years) undergoing circumcision. CB is associated with a trend towards longer duration of analgesia, but is associated with prolonged urinary retention and delayed ambulation. CB use is reco

关键词： Circumcision Caudal block penile block

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