Comparison of dorsal penile nerve block and caudal block for postoperative analgesic efficacy in pediatric patients undergoing penile surgery with general anesthesia: a meta-analysis / 中华麻醉学杂志

ABSTRACT

Objective:To systematically evaluate the efficacy of dorsal penile nerve block (DPNB) and caudal block (CB) for analgesia after penile surgery under general anesthesia in the pediatric patients.Methods:Databases including PubMed, EMbase, Web of Science, the Cochrane Library, Wanfang, VIP, CNKI and CBM were searched to collect the randomized controlled trials involving DPNB and CB for penile surgery under general anesthesia in children from inception to September 2021.Meta-analysis was performed using RevMan 5.4 software.Results:Sixteen randomized controlled trials involving 1 271 pediatric patients were enrolled.The results of meta-analysis showed that the requirement for analgesic drugs during recovery was significantly lower in CB group than in DPNB group ( RR=2.54, 95% CI 1.19-5.40, P=0.020); the time of first postoperative activity was significantly shortened ( SMD=-0.68, 95% CI -1.23--0.13, P=0.020), and the incidence of postoperative motor block was decreased ( RR=0.05, 95% CI 0.01-0.16, P<0.001) in DPNB group as compared with CB group.There were no significant differences in the incidence of intraoperative block failure ( RR=1.25, 95% CI 0.62-2.51, P=0.530) between two groups.There were no significant differences in objective pain scores at awakening ( SMD=-0.29, 95% CI -0.01-0.59, P=0.050), at 1 h after surgery ( SMD=1.02, 95% CI -1.37-3.41, P=0.400), or at 2 h after surgery ( SMD=0.05, 95% CI -0.59-0.68, P=0.880) between two groups.There were no significant differences in the incidence of agitation during recovery ( RR=0.71, 95% CI 0.44-1.14, P=0.150) between two groups.There were no significant differences in the time of first urination ( MD=-84.52, 95% CI -195.72-26.69, P=0.140) between two groups.There were no significant differences in the incidence of postoperative nausea and vomiting ( RR=0.56, 95% CI 0.29-1.07, P=0.080) between two groups. Conclusions:DPNB and CB provide similar postoperative analgesic efficacy, but DPNB can prevent the occurrence of postoperative motor block, which is helpful for the postoperative rehabilitation in the pediatric patients undergoing penile surgery with general anesthesia.