Chan KH, et al. - A comparative exploration was pursued of the intraoperative and 1-hour postoperative outcomes in caudal vs dorsal penile nerve block (DPNB) patients undergoing penile surgeries. It was noted that caudal blocks could display a minor advantage in the immediate postoperative period. However, its cost-effectiveness remained unproven.

Methods

• The enrollment consisted of males <10 years old undergoing penile procedures (2013-2015), from the Pediatric Regional Anesthesia Network, Pediatric Health Information System databases and our medical records.
• The primary outcome included a maximum Faces Limbs Activity Crying Consolability pain score > 3.
• Intraoperative/post-anesthesia care unit (PACU) narcotics, pre-incision anesthesia time, adjusted operating room charges and complications were included as the secondary outcomes.
• Bivariate and multivariable analyses were pursued, controlling for demographic/procedure characteristics and clustering by surgeon.

Results

• Among the 738 patients, (mean age 2.1 years) 74.1% had a caudal.
• DPNB patients exhibited a greater tendency of having a maximum pain score >3 (19.5% vs. 8.1%, p < 0.0001), received intraoperative (33.0% vs.2.9%, p < 0.0001) and PACU narcotics (15.7% vs. 7.5% vs. p=0.0009), displayed a shorter pre-incision anesthesia time (19.5 vs. 27.9 minutes, p < 0.0001) and lower adjusted operating room charges ($9,402 vs. $12,760, p < 0.0001).
• The bivariate logistic regression disclosed that DPNB patients illustrated 2.7 times the odds of a maximum pain score > 3 (95% CI 1.7- 4.4, p < 0.0001) and 5.2 times the odds of intraoperative/PACU narcotic administration (95% CI 3.3-8.1, p < 0.0001).
• The multivariable analyses unveiled that caudal patients presented with a longer pre-incision anesthesia time (27.9 ± 7.4 vs. 19.5 ± 6.6 minutes, p < 0.0001) and higher adjusted operating room charges ($12,760 ± 4077 vs. $9,402 ± 3741, p=0.01).