Abstract
Penile block (PB) in adults is not a well-recognized technique. The aim of this study was to compare, in a randomized prospective manner, five different techniques of PB in 250 adults undergoing circumcision with regard to anaesthetic quality, complications and postoperative analgesia. Patients were divided into five groups (50 per group) according to the technique used: Group A — “10, 30–13, 30” approach; Group B — the subpubic approach; Group C — subcutaneous ring block; Group D — a combination of frenulum infiltration and the “10, 30–13, 30” approach; Group E — a combination of frenulum infiltration and the subpubic approach. The number of failed blocks in Groups A and B (41 and 43 respectively) was greater than in Groups C, D and E (2, 3 and 5 respectively) (P < 0.001). The five groups did not differ with regard to adverse effects or time until the onset of postoperative pain when the blocks were successful. It is concluded that good surgical anaesthesia, a low rate of adverse effects and prolonged postoperative analgesia can be achieved by the use of either subcutaneous ring block or a combination of dorsal nerve block (using the “10, 30–13, 30” or the subpubic approach) and infiltration of the frenulum. These approaches to the PB are effective anaesthetic techniques for circumcision in adults.
Résumé
Chez l’adulte, le bloc du pénis (PB) ne constitue pas une technique généralement acceptée. Cette étude prospective et randomisée vise à comparer cinq différentes techniques de BP chez 250 adultes soumis à une circoncision, au regard de la qualité de l’anesthésie, des complications et de l’analgésie postopératoire. Les patients sont divisés en cinq groupes (50 par groupe) selon la technique utilisée: le groupe A — l’approche «10:30–13:30» le groupe B — l’approche suspubienne; le groupe C — l’infiltration sous- cutanée en bague, le groupe D — une combinaison d’infiltration du frein avec approche «10:30 –13:30»; le groupe E — une combinaison d’infiltration du frein avec approche sus-pubienne. Le nombre des échecs dans les groupes A et B (41 et 43 respectivement) est plus grand que dans les groupes C, D, et E (2,3 et 5 respectivement, P < 0,001). Lorsque le bloc est réussi, les cinq groupes sont identiques entre eux au regard des effets secondaires ou du délai de l’apparition de la douleur. En conclusion, avec une infiltration sous-cutanée en bague ou une combinaison du bloc du nerf dorsal (approche 10,30–13,30 ou sus-pubienne), on peut obtenir une bonne anesthésie chirurgicale, un faible pourcentage d’effets secondaires et une analgésie postopératoire prolongée. Ces approches du bloc pénien sont des techniques anesthésiques efficaces pour la circoncision de l’adulte.
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Szmuk, P., Ezri, T., Ben Hur, H. et al. Regional anaesthesia for circumcision in adults: a comparative study. Can J Anaesth 41, 1181–1184 (1994). https://doi.org/10.1007/BF03020658
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DOI: https://doi.org/10.1007/BF03020658