Comparative randomized clinical trial on postoperative pain in circumcision with ultrasound-guided versus conventional anesthetic block

Abstract

Objective  Circumcision is a common surgical procedure worldwide, with indications ranging from medical to cultural-religious contexts. Effective pain control is crucial to reduce analgesic use and improve patient safety. Recent advances include the use of the Plastibell® device and ultrasound-guided dorsal penile nerve block, aimed at minimizing surgical time and complications. This study compares postoperative pain in patients undergoing circumcision with either the landmark dorsal penile nerve block (blind block) or ultrasound-guided block.

Methods  In this prospective, randomized study, patients aged 3-14 years undergoing elective circumcision were assigned to receive either anesthetic technique. Pain was assessed using physiological parameters (heart rate variation, movement during surgery) and subjective measures (Wong-Baker scale) at multiple time points, along with analgesic consumption. The sample was subdivided into patients aged ≤5 years and >5 years.

Results  Pain scores before hospital discharge were higher in patients under 5 years. The blind block was faster to perform but had a higher incidence of hematomas and a trend toward greater block failure, indicated by increased heart rate, patient movement, and opioid use, although differences were not statistically significant. Ultrasound-guided blocks showed fewer complications and a tendency for better pain control.

Conclusion  Both anesthetic techniques provide comparable pain control in circumcision; however, ultrasound guidance may reduce complications and improve block success, supporting its use as a safe and effective alternative to the conventional method.

Keywords
Phimosis; Plastibell®; Circumcision; Postoperative pain; Ultrasound