To investigate the efficacy of ultrasound-guided modified dorsal penile nerve block for circumcision in the pediatric patients.

Eighty pediatric patients, of American Society of Anesthesiologists physical status Ⅰ, aged 5-12 yr, weighing 15-52 kg, undergoing elective circumcision, were randomly divided into 2 groups (n=40 each) using a random number table: ultrasound-guided modified dorsal penile nerve block group (group A) and ultrasound-guided traditional dorsal penile nerve block group (group B). Propofol was given by target-controlled infusion (Marsh mode) to maintain anesthesia, the initial target effect-site concentration was 2 μg/ml, and the target effect-site concentration was increased by an increment of 1 μg/ml when necessary.The children were placed in the dorsal lithotomy position in group A. The ultrasound probe was placed in a coronal parallel plan just beneath the skin of the scrotum.The needle was inserted at the site 0.5 cm lateral to the probe, and advanced directly until the tip of the catheter was placed into the penile neurovascular sheath.When blood was not found after withdrawing from the catheter, the mixture (0.1 ml/kg) of 1% lidocaine and 0.375% ropivacaine was injected.The ultrasound image showed that the neurovascular sheath was infiltrated with drug liquid and expanded, and the equal volume of local anesthetics was given on the other side of the probe.Group B underwent traditional dorsal penile nerve block with the mixture (0.2 ml/kg) of 1% lidocaine and 0.375% ropivacaine 0.2 ml/kg.The total consumption of propofol, emergence time, and occurrence of bradycardia during operation and emergence, intraoperative body movement and respiratory depression, and adverse reactions such as postoperative agitation, nausea, vomiting, urinary retention and pruritus were also recorded.Paracetamol suppositories were used as rescue analgesic after operation, and the requirement was recorded.The puncturing time and success rate, and puncture-induced penile swelling were also recorded.

No pediatric patients developed intraoperative and postoperative bradycardia, and postoperative nausea, vomiting, agitation, urinary retention and pruritus in the two groups.Compared with group B, the total consumption of propofol was significantly decreased, the emergence time was significantly shortened, the requirement for paracetamol suppositories and incidence of body movement and penile swelling were significantly decreased, the puncturing time was significantly shortened (P<0.05), and no significant difference was found in the incidence of respiratory depression in group A (P>0.05). The success rate of puncture was 100% in the two groups.

Ultrasound-guided modified dorsal penile nerve block is safe and effective when used for circumcision in the pediatric patients, and it is superior to ultrasound-guided traditional block.

Ultrasonography; Child; Nerve block; Circumcision, male