Caudal Block With Intravenous Sedation and Natural Airway Provides Adequate Anesthesia and Analgesia for Circumcision in Young Patients

IntroductionDuring the newborn period, circumcision is performed under local anesthesia, but for older infants it is typically performed by general surgeons or urologists under general anesthesia. Recent literature debates over a concern for neurotoxicity associated with general anesthesia in the developing brain, and it is important to create techniques to decrease exposure to neurotoxic agents while still allowing safe performance of procedures. We performed a prospective feasibility study performing circumcision with use of caudal block as the primary anesthetic with a natural airway under dexmedetomidine sedation.MethodsThis is a single-institution, prospective comparative study of male patients undergoing outpatient circumcision ages 2 to 24 months. A 1:3 case-control match was utilized. Patients underwent circumcision with natural airway, caudal block, and dexmedetomidine sedation compared to patients performed under general anesthesia. The primary endpoint was successful performance of the operation and secondarily assessed operative times, total-OR times, and intra- and postoperative medication use.Results27 patients were enrolled in the study. Of the 27 patients, 23 (85%) successfully tolerated the procedure after caudal block was performed. Four patients required conversion to placement of an LMA for deeper sedation. Patients had similar OR and operative times, with significantly less Sevoflurane exposure time and less postoperative fentanyl use compared to control.ConclusionCaudal block with intravenous sedation is a feasible alternative to maintaining general anesthesia during circumcision in young patients. It avoids prolonged airway instrumentation and provides adequate intra- and postoperative analgesia without increased postoperative pain or change in expected recovery time.Level of EvidenceLevel 2; prospective comparative study.