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. 2023 Dec 4:10:1268594.
doi: 10.3389/fmed.2023.1268594. eCollection 2023.

Pediatric ultrasound-guided dorsal penile nerve block and sedation in spontaneous breathing: a prospective observational study

Bruno Dottore #  1 , Francesco Meroi #  2   3 , Serena Tomasino  3 , Daniele Orso  2   3 , Matteo Comuzzi  2   3 , Nicola Vernaccini  4 , Luigi Vetrugno  5   6 , Sergio Intini  4   7 , Tiziana Bove  2   3
Affiliations

Pediatric ultrasound-guided dorsal penile nerve block and sedation in spontaneous breathing: a prospective observational study

Bruno Dottore et al. Front Med (Lausanne). .

Abstract

Background: Worldwide, one of the most common surgical procedures in the pediatric population is circumcision. There is no consent on the best anesthesiologic approach. This study aimed to investigate ultrasound-guided dorsal penile nerve block (DPNB) plus sedation in spontaneous breathing as a time-saving, safe, effective, and opioid-sparing technique.

Aims: The primary outcome was the assessment of the time from the end of surgery and the discharge to the post-anesthesia care unit. Secondary outcomes were to evaluate the cumulative dosages of opioids, differences in pain levels between the two groups, and complications at the awakening, 4 h and 72 h after surgery, respectively.

Methods: This was a prospective study with a retrospective control group, approved by the Friuli-Venezia Giulia Ethics Committee. Children in the intervention group received an ultrasound-guided DPNB under sedation and spontaneous breathing. With the probe positioned transversally at the base of the penis using an in-plane approach with a modified technique, local anesthetic was injected under the deep fascia of the penis.

Results: We recruited 70 children who underwent circumcision at the University Hospital of Udine, Italy, from 1 January 2016 to 1 October 2021: 35 children in the ultrasound-guided DPNB group and 35 children in the control group. Children who received ultrasound-guided DPNB had a statistically significant lower time to discharge from the operating room, did not require mechanical ventilation, maintained spontaneous breathing at all times, received fewer opioids, had lower mean intraoperative arterial pressures, and lower pain levels immediately after surgery.

Conclusion: Ultrasound-guided DPNB associated with sedation and spontaneous breathing is a time-saving, opioid-sparing, safe, and effective strategy for the management of intraoperative and postoperative pain in children undergoing circumcision.Clinical trial registration: ClinicalTrial.gov (NCT04475458, 17 July 2020).

Keywords: circumcision; dorsal penile nerve block; laryngeal mask; mechanical ventilation; pediatric; sedation; spontaneous breathing; ultrasound.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
Anatomy of the penis and ultrasound probe position.
Figure 2
Figure 2
Sequence of ultrasound images of the dorsal penile nerve block. (A) Anatomy of the penis, (B) local anesthetic injection on the right-hand side, (C) local anesthetic injection in the median region, and (D) local anesthetic injection on the left-hand side.
Figure 3
Figure 3
Time to discharge from the end of surgery into the post-anesthesia care unit. DPNB, dorsal penile nerve block.
See this image and copyright information in PMC

References

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