Compared Reversed US-Guided Dorsal Penile Nerve Block (RUSDPNB) With DPNB in Circumcisions for Pediatric Patients (CIRCUSPRO)

A Comparison of Reversed-Ultrasound-Guided Dorsal Penile Nerve Block (RUS-DPBP) and DPNB in Circumcisions for Pediatric Patients

Circumcision is a widely performed surgical procedure. For this reason, optimal analgesic management is essential. Loco-regional anesthesia, particularly penile blocks, combined with general anesthesia is the technique of choice for managing analgesia during circumcisions.

Ultrasound is increasingly used in locoregional anesthesia techniques. There is already human research on penile blocks and the use of ultrasound. Studies carried out to date describe an optimization of pain relief in children after circumcision compared with the alternative technique without ultrasound, as well as a reduction in local complications due to injection. However, other studies tend to contradict these findings.

In order to provide additional knowledge and to verify whether ultrasound could provide with more optimal relief after your circumcision, the investigators are carrying out this study.

The investigators are proposing to every patient aged 0 to under 18 who is going to undergo circumcision to take part in this project. A letter is sent to all potential participants no later than 3 days before the operation. Consent can be signed no later than the day of the operation. The cooling-off period is the same regardless of age.

Taking part in the study does not affect the operation in any way. The block will take place in the operating room, prior to surgery.

In this study, participants are randomized into groups. This method is important for obtaining reliable results.

• Group 1 (intervention group): The penile block will be performed using ultrasound.
• Group 2 (control group): The penile block will be performed using anatomical landmarks.

This is a "single-blind" study, which means that only the anaesthetists, investigators and operating room team will be aware of the allocation to one of the two groups.

Data on opiate consumption will be registered as well as the different durations preoperatively, intraoperatively, postoperatively, back in the recovery room and before returning home or any complications as well as pain assessment.

Study Overview

• Status: Recruiting
• Conditions: Ultrasound; Opioid Consumption; Circumcision; Penile Surgery
• Intervention / Treatment: Procedure: Using ultrasound for penile nerve block; Procedure: Dorsal Penile Block Anesthesia using landmarks

Detailed Description

30% of men over the age of fifteen worldwide have had a circumcision according to a World Health Organization report. This operation is common and should not be trivialized. A certain number of surgical complications should be considered, including pain, infections, excessive bleeding or hematomas. Today, the use of opioids as intra- and postoperative analgesics in pediatric urological surgery remains predominant but is the subject of increasing controversies. Indeed, the recent opioid crisis challenges us about their use and highlights their multiple side effects. First of all, their use involves significant risks, including opioid-induced hyperalgesia and potential long-term effects. An increase in pain sensitivity within the 24 postoperative hours being proportional to intraoperative administration of high doses of opioids can be observed. Long-term addiction is also questioned. Then, opioids don't appear to be the most effective per- and postoperative analgesic drug. Its prescription could and should be reduced. In sum, a safe and effective anesthesia is paramount. Use of loco-regional anesthesia (LRA) during pediatric urological surgeries complements general anesthesia and thus offers more optimal postoperative analgesia.

Dorsal penile nerve block (DPNB) is LRA technique of choice for circumcisions and aims to anesthetize both dorsal penile nerves. The name DPNB is used for blocks performed by determining precise dorsal anatomical landmarks and doing two distinct injections. The main complications observed are lesions of the urethra, vascular complications (bleeding from the prepuce; hematomas) and failure of the block. In recent years, Ultrasound (US), a non-irradiating imaging technique widely used in LRA, has been used more and more to perform the DPNB and the procedure is well known and described. A decrease of the amount of opioid analgesics intraoperatively and postoperatively is observed when US is used. Postoperative pain scores are also better. Two methods of DPNB using US exist. In both approaches, probe is placed along the transverse plan. In the first one at the base of penis, with ventral visualization of structures, US-DPNB. In the second method, Reversed Ultrasound-Guided DPNB (RUS-DPNB), the penis is slightly retracted with probe placed dorsally, under the base of penis and above the scrotum. RUS-DPNB method will be used in this study. However, DPNB and RUS-DPNB are well described and used equally in daily practice.

The aim of this prospective study is to compare DPNB and RUS-DPNB in terms of efficacy, using cumulative analgesic dosage in morphine equivalent per kilogram. In the standard practice, the two methods are performed at discretion of every anaesthesiologist at CHUV. In fact, although RUS-DPNB is part of everyday practice at CHUV, it hasn't become the standard method, as the literature has a lack of data to prove its advantage over the standard method, DPNB.

• Study Type: Interventional
• Enrollment (Estimated): 216
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Boand Mélanie, Research nurse; Phone Number: +41 79 556 82 92; Email: melanie.boand@chuv.ch
• Study Contact Backup: Name: Sylvain Mauron, Dr Med; Phone Number: +41797046359; Email: sylvain.mauron@chuv.ch

Study Locations

• Switzerland
  • Canton of Vaud
    • Lausanne, Canton of Vaud, Switzerland, 1011
      • Recruiting
      • Centre Hospitalier Universitaire Vaudois
      • Contact: sylvain Mauron, Dr Med

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• male
• undergoing circumcision
• informed consent

Exclusion Criteria:

• other surgery than circumcision in the same time
• contraindication to local anesthesia
• allergy to bupivacaine
• chronic opiates treatment

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: interventional; Dorsal penile nerve block using ultrasound	Procedure: Using ultrasound for penile nerve block; 30% of men over the age of fifteen worldwide have had a circumcision according to a World Health Organization report. (1) This operation is common and should not be trivialized. A certain number of surgical complications should be considered, including pain, infections, excessive bleeding or hematomas. (1,2) Today, the use of opioids as intra- and postoperative analgesics in pediatric urological surgery remains predominant (3) but is the subject of increasing controversies. Indeed, the recent opioid crisis challenges us about their use and highlights their multiple side effects. First of all, their use involves significant risks, (4) including opioid-induced hyperalgesia and potential long-term effects. An increase in pain sensitivity within the 24 postoperative hours being proportional to intraoperative administration of high doses of opioids can be observed. (5) Long-term addiction is also questioned. Then, opioids don't appear to be the most effective per- and postoperative analgesi
Active Comparator: Control; Dorsal penile nerve block using anatomical landmarks	Procedure: Dorsal Penile Block Anesthesia using landmarks; Dorsal penile nerve block (DPNB) is LRA technique of choice for circumcisions and aims to anesthetize both dorsal penile nerves. (10-12) The name DPNB is used for blocks performed by determining precise dorsal anatomical landmarks and doing two distinct injections.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Total morphine equivalent	total morphine equivalent will be cumulated and reported	from enrollment to discharge from hospital, maximum 1 day

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
times	- Anesthesia time, surgery time, total time in operating room, time in recovery room, time before discharge home	from enrollment to discharge from hospital, maximum 1 day
Adverse events	- Incidence of adverse events of special interest (complications such as urine retention, bleeding and hematoma, nausea and vomiting).	from enrollment to discharge from hospital, maximum 1 day
Pain score using Face Leg Activity Cry Consolability (FLACC) or FACES or Visual Analog Scale (VAS), from 0 (no pain) to 10 (worse pain)	Maximal pain score measured and reported	from enrollment to discharge from hospital, maximum 1 day

Collaborators and Investigators

• Sponsor: Centre Hospitalier Universitaire Vaudois

Publications and helpful links

General Publications

• O'Sullivan MJ, Mislovic B, Alexander E. Dorsal penile nerve block for male pediatric circumcision--randomized comparison of ultrasound-guided vs anatomical landmark technique. Paediatr Anaesth. 2011 Dec;21(12):1214-8. doi: 10.1111/j.1460-9592.2011.03722.x.
• Kirya C, Werthmann MW Jr. Neonatal circumcision and penile dorsal nerve block--a painless procedure. J Pediatr. 1978 Jun;92(6):998-1000. doi: 10.1016/s0022-3476(78)80386-2.
• Osmani F, Ferrer F, Barnett NR. Regional anesthesia for ambulatory pediatric penoscrotal procedures. J Pediatr Urol. 2021 Dec;17(6):836-844. doi: 10.1016/j.jpurol.2021.07.017. Epub 2021 Jul 24.
• Carolan AMC, Parker KM, Grimsby GM. Opioid Use after Pediatric Urologic Surgery: Is It Really Needed? Urology. 2021 Dec;158:184-188. doi: 10.1016/j.urology.2021.04.012. Epub 2021 Apr 24.

Study record dates

Study Major Dates

• Study Start (Actual): November 29, 2024
• Primary Completion (Estimated): November 1, 2026
• Study Completion (Estimated): September 1, 2027

Study Registration Dates

• First Submitted: November 20, 2024
• First Submitted That Met QC Criteria: November 22, 2024
• First Posted (Actual): November 26, 2024

Study Record Updates

• Last Update Posted (Actual): March 27, 2026
• Last Update Submitted That Met QC Criteria: March 24, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: circumcision; reversed ultrasound guided dorsal penile nerve block
• Additional Relevant MeSH Terms: Physiological Effects of Drugs; Central Nervous System Depressants; Anesthetics
• Other Study ID Numbers: 2024-00420

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: all IPD that underlie results in a publication
• IPD Sharing Time Frame: Beginning 1 year after publication with no end date
• IPD Sharing Access Criteria: Any researcher or journal contacting the PI with clear and well-founded request
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ANALYTIC_CODE; CSR

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No