Is penile block better than caudal epidural block for postcircumcision analgesia?

Purpose To compare caudal and penile block for post-operative analgesia in children undergoing circumcision with respect to efficacy, complication rates, and parental satisfaction.Methods The study population consisted of 100 ASA 1 and 2 boys aged 3 to 8 years who were undergoing circumcision for religious reasons. In all participants, inhalation anesthesia was administered with oxygen:nitrous oxide (1:2) and halothane. The participants were allocated randomly into two groups of 50 children each. Group 1 received penile block and Group 2 caudal block. The penile block was achieved by injecting bupivacaine into the two compartments of the subpubic space, with an additional ventral infiltration of a small volume of bupivacaine along the raphe of the penis. For caudal block, 1ml·kg^–1 body weight of 0.25% bupivacaine was administered.Results Penile block shortened the induction-incision time and enabled earlier discharge home compared with caudal block. One patient undergoing penile block and nine patients undergoing caudal block vomited.Conclusions Penile and caudal block are equally effective for postcircumcision analgesia and neither is associated with serious complications. Anesthesiologist preference should be the deciding factor in choosing one technique over the other.     

Neurolytic celiac plexus block for visceral abdominal malignancy: is prior diagnostic block warranted?

Neurolytic celiac plexus block is a recognised treatment for visceral abdominal pain due to malignancy. The need for a diagnostic celiac plexus block prior to neurolytic blockade is of questionable value, as it may not predict a positive response and may incorrectly predict a lack of response. Our objective is to evaluate the efficacy of diagnostic celiac plexus block. The records of 59 patients treated with celiac plexus block during 1994-2000 were retrospectively reviewed. Diagnostic block was performed on 32 patients prior to the decision for subsequent neurolytic block (Group 1). Another 27 patients were directly treated with a neurolytic celiac plexus block (Group 2). Response of Group 1 to diagnostic and neurolytic blocks was compared. Data from Group 2 was used to project the response of Group 1 should those patients with negative response to diagnostic block proceeded to neurolytic block. A two-by-two table was then constructed. The diagnostic celiac plexus block predicted a positive response with a sensitivity of 93% and a specificity of 37%. The positive predictive value was 85% and the negative predictive value was 58%. The estimated "number needed to test" before a "true" nonrespondent to lytic block to be detected was 16.7. Therefore, a positive response to diagnostic block correlates positively with neurolytic celiac plexus block for abdominal visceral pain due to malignancy. However, diagnostic block is a poor predictor when the response is negative. Hence, its clinical role is questionable and may not be warranted for patients with terminal malignancy.     

Subdural block complicating spinal anesthesia?

IMPLICATIONS:Features suggestive of subdural block appeared after an apparently normal subarachnoid block. The long bevel of the reusable Quincke-type spinal needle may have contributed to the development of this complication. We propose that spinal needles should have a smaller bevel to minimize the possibility of such a complication.     

The paravertebral nerve root block for inguinal herniorrhaphy—A comparison with the field block approach

Background and Objectives. Our objective was to evaluate the efficacy of the paravertebral block for inguinal herniorrhaphy by comparison with the well-established field block. Methods. Thirty patients undergoing inguinal herniorrhaphy were randomly divided into two groups. Group A (n = 15) received paravertebral block of the ipsilateral nerve roots of T12, L1, and L2. Group B (n = 15) received field block. Each block was evaluated in terms of the degree of patient discomfort associated with surgical manipulations, requirement for supplemental anesthetic, the degree of patient discomfort associated with block performance, and the overall degree of patient satisfaction. Results. Both approaches were successful in blocking somatic sensory fibers. The paravertebral approach showed a significantly higher success rate than the field block (P < .01), regarding frequency of pain relative to surgical manipulation of the spermatic cord, hernial sac, and also in terms of need to supplement the surgery with local anesthetic (P < .01). The paravertebral block required significantly less local anesthetic and less needle insertions than the field block. Conclusions. The paravertebral nerve root block proved to be superior to the field block, to be devoid of side effects, and was acceptable to the patients.