Pain Management and Postoperative Outcomes in Circumcisions

Opioid stewardship efforts with non-narcotic analgesic regimens in the perioperative setting optimize outcomes. Standardized protocols for pediatric patients undergoing circumcision are lacking. To evaluate current practices, a retrospective chart review was conducted on 354 pediatric patients who underwent circumcision at a children's hospital. Analgesic use, intraoperative block use, and patient outcomes were analyzed. Intraoperatively, 57.6% of patients received at least one narcotic analgesic, with 28.4% receiving additional doses. Patients who underwent a caudal block required no narcotics at any phase, while those without a block received narcotics in the perioperative period. Outcomes were similar between patients who did or did not receive caudal blocks or NSAIDs, specifically, there was no difference in incidence of bleeding. These findings suggest that regional nerve blocks and NSAIDs may not increase risk and may provide effective pain control for pediatric patients undergoing circumcisions, reducing or eliminating the need for narcotics and therefore optimizing care.