A comparison of caudal bupivacaine and ketamine with penile block for paediatric circumcision

Background and Objectives: To establish whether caudal with ketamine or penile block provide superior postoperative analgesia for paediatric circumcision. Method: This was a single centre, prospective, randomized, controlled, double-blind trial. Forty males (aged between 1.8 months and 16 yr) were randomized to receive either a penile block using 0.25 mL kg(-1) 0.5% bupivacaine (Group P), or a caudal block Using 0.5 mL kg(-1) 0.25% bupivacaine with 0.5 mg kg(-1) ketamine (Group Q. All of them were given a standard anaesthetic and rectal paracetamol 40 mg kg(-1) and diclofenac 1-1.5 mg kg(-1). Postoperative pain scores were assessed in recovery and the time to first analgesia, micturition and walking were recorded. Results: There were no failures in either group. The time to first analgesia was longer in Group C (C median = 459 min, interquartile range 374-553 min; P median = 374 min, interquartile range 224-507 min; P < 0.05). There was a delay in time to walking in Group C (C median = 162 min, interquartile range 119-208 min; P median 120 min, interquartile range 92-132 min; P < 0.05). There was no difference between the groups in time to waking or micturition, or the incidence of vomiting, abnormal behaviour or bleeding. Conclusion: Caudal bupivacaine with ketamine and penile block both provide effective postoperative analgesia for circumcision when given with non-steroidal anti-inflammatory drugs. This Study shows that caudal bupivacaine with ketamine provides a longer duration of analgesia than penile block, but also causes delay in walking.