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Meta-Analysis
. 2008 Oct 8;2008(4):CD003005.
doi: 10.1002/14651858.CD003005.pub2.

Caudal epidural block versus other methods of postoperative pain relief for circumcision in boys

Allan M Cyna  1 , Philippa Middleton
Affiliations
Meta-Analysis

Caudal epidural block versus other methods of postoperative pain relief for circumcision in boys

Allan M Cyna et al. Cochrane Database Syst Rev. .

Abstract

Background: Techniques to minimize the postoperative discomfort of penile surgery, such as circumcision, include caudal block; penile block; systemic opioids and topical local anaesthetic cream, emulsion or gel.

Objectives: To compare the effects of caudal epidural analgesia with other forms of postoperative analgesia following circumcision in boys.

Search strategy: We searched CENTRAL (The Cochrane Library 2008, Issue 1), MEDLINE (to April 2008) and EMBASE (to April 2008).

Selection criteria: Randomized and quasi-randomized trials of postoperative analgesia by caudal epidural block compared with non-caudal analgesia in boys, aged between 28 days and 16 years, having elective surgery for circumcision.

Data collection and analysis: Two review authors independently carried out assessment of study eligibility, data extraction and assessment of the risk of bias in included studies.

Main results: We included 10 trials involving 721 boys. No difference was seen between caudal and parenteral analgesia in the need for rescue or other analgesia (relative risk (RR) 0.41, 95% confidence interval (CI) 0.12 to 1.43; 4 trials, 235 boys; random-effects model) or on the incidence of nausea and vomiting (RR 0.61, 95% CI 0.36 to 1.05; 4 trials, 235 boys). No difference in the need for rescue or other analgesia was seen for caudal compared with dorsal nerve penile block (DNPB) (RR 1.25, 95% CI 0.64 to 2.44; 4 trials, 336 boys; random-effects model). No differences were seen between caudal block and DNPB in the incidence of nausea and vomiting (RR 1.88, 95% CI 0.70 to 5.04; 4 trials, 334 boys; random effects model) or individual complications except for motor block (RR 17.00, 95% CI 1.01 to 286.82; 1 trial, 100 boys) and motor or leg weakness (RR 10.67, 95% CI 1.32 to 86.09; 2 trials, 107 boys). These were significantly more common in the caudal block groups than with DNPB. No differences were seen between caudal and rectal or intravenous analgesia in the need for rescue analgesia or any other outcomes (2 trials, 162 boys).

Authors' conclusions: Differences in the need for rescue or other analgesia could not be detected between caudal, parenteral and penile block methods. In day-case surgery, penile block may be preferable to caudal block in children old enough to walk due to the possibility of temporary leg weakness after caudal block. Evidence from trials is limited by small numbers and poor methodology. There is a need for properly designed trials comparing caudal epidural block with other methods such as morphine, simple analgesics and topical local anaesthetic creams, emulsions or gels.

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Conflict of interest statement

None known

Figures

1.1
1.1. Analysis
Comparison 1 Caudal analgesia versus parenteral analgesia, Outcome 1 Need for analgesia.
1.2
1.2. Analysis
Comparison 1 Caudal analgesia versus parenteral analgesia, Outcome 2 Nausea or vomiting.
2.1
2.1. Analysis
Comparison 2 Caudal analgesia versus dorsal nerve penile block, Outcome 1 Need for any analgesia (rescue or other).
2.2
2.2. Analysis
Comparison 2 Caudal analgesia versus dorsal nerve penile block, Outcome 2 Need for rescue analgesia.
2.3
2.3. Analysis
Comparison 2 Caudal analgesia versus dorsal nerve penile block, Outcome 3 Other analgesia.
2.4
2.4. Analysis
Comparison 2 Caudal analgesia versus dorsal nerve penile block, Outcome 4 Pain score.
2.5
2.5. Analysis
Comparison 2 Caudal analgesia versus dorsal nerve penile block, Outcome 5 Complications.
2.6
2.6. Analysis
Comparison 2 Caudal analgesia versus dorsal nerve penile block, Outcome 6 Time to discharge home (mins).
2.7
2.7. Analysis
Comparison 2 Caudal analgesia versus dorsal nerve penile block, Outcome 7 Parental satisfaction.
2.8
2.8. Analysis
Comparison 2 Caudal analgesia versus dorsal nerve penile block, Outcome 8 Procedural time (mins).
3.1
3.1. Analysis
Comparison 3 Caudal analgesia versus rectal or intravenous, Outcome 1 Need for any analgesia (rescue or other).
3.2
3.2. Analysis
Comparison 3 Caudal analgesia versus rectal or intravenous, Outcome 2 Need for rescue analgesia.
3.3
3.3. Analysis
Comparison 3 Caudal analgesia versus rectal or intravenous, Outcome 3 Other analgesia.
3.4
3.4. Analysis
Comparison 3 Caudal analgesia versus rectal or intravenous, Outcome 4 Complications.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Bramwell 1982 {published data only}
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