Analgesia for Pediatric Circumcision : Comparison of the Effectiveness of Pudendal Nerve Block to Penile Nerve Block

Centre Hospitalier Universitaire Saint Pierre

Status: Unknown

Conditions: Pediatric Circumcision; Anesthesia

Treatments: Procedure: Penile nerve block; Procedure: Pudendal nerve block

Study type: Interventional

Funder types: Other

Identifiers

NCT04227561

B076201941947

Details and patient eligibility

About

Medical or ritual circumcisions are frequent interventions in children. To provide the best comfort to the patients, the anesthetists use regional anesthesia. Complementary to general anesthesia, this method allows to lower the need of opioids during and after the surgery, as well as a faster recovery.

The foreskin is innervated by the dorsal nerve of the penis which is the branch of the pudendal nerve. This nerve arises from the sacral plexus and more precisely the branches S2-3-4. There are two methods to block pudendal nerve. First, the pudendal nerve block is an old anesthetic technique developed in 1908, first for obstetrical analgesia and urological analgesia. It consists in injecting in the ischiorectal fossa, right at the end of Alcock's canal, a solution of local anesthetic. Second, the penile nerve block, described in the middle of the seventies, consists in injecting a solution of local anesthetic that blocks only the terminal part of the pudendal nerve.

Those two nerve blocks have been subject to many publications, especially concerning the method to apply to optimize their efficiency. The literature review led to this conclusion: The penile nerve block should be ultrasound guided and the pudendal nerve block should be done with a neurostimulator.

The aim of this study is to compare the analgesic efficiency of the ultra-sound guided penile nerve block to the pudendal nerve block with neurostimulation, for the pediatric circumcision.

Enrollment: 40 estimated patients

Sex: Male

Ages: 1 to 2 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• One to two years old boys
• Ritual or medical, elective circumcision.

Exclusion criteria

• Refusal from parents
• Allergy to local anesthetics
• Documented coagulation disorders
• Epilepsy

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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40 participants in 2 patient groups

Pudendal nerve block

Active Comparator group

Description:

Neurostimulation-guided pudendal nerve block

Treatment:

Procedure: Pudendal nerve block

Penile nerve block

Active Comparator group

Description:

Ultrasound-guided penile nerve block

Treatment:

Procedure: Penile nerve block