Comparison of 3 regional anesthetic techniques for circumcision in obese children: A retrospective observational study

Circumcision is a frequently performed pediatric surgical procedure, yet effective pain management remains a challenge, particularly in obese children. While regional anesthesia is widely used, comparative data on its efficacy in this population are limited. This study evaluates 3 regional anesthetic techniques for circumcision in obese pediatric patients. We conducted a retrospective observational study of obese children (age ≥ 6 years) who underwent circumcision between May 1, 2021, and September 30, 2024. Patients were grouped by anesthesia type: perineal approach dorsal penile nerve block with ultrasound guidance (DPNB-US), dorsal penile nerve block with landmarks (DPNB-LM), and caudal epidural anesthesia (CEA). Primary outcomes included rescue analgesia requirement within 6 hours postoperatively. Secondary outcomes encompassed intraoperative opioid use, postoperative sufentanil administration in the PACU, complications, and parental satisfaction. A total of 235 obese children were included, comprising 58 in the DPNB-US group, 104 in the DPNB-LM group, and 73 in the CEA group. The CEA group exhibited the highest immediate postoperative analgesia demand (91.8%, 67/73), which was significantly higher than that in the DPNB-LM group (12.5%, 13/104) and the DPNB-US group (6.9%, 4/58) (P < .001). The proportion of patients requiring rescue opioids either intraoperatively or in the PACU was significantly lower in the CEA group compared to the DPNB-LM group (4.1% vs 36.5% and 2.8% vs 13.5%, respectively; P < .001). The CEA group showed significantly lower satisfaction (67.1%) compared to the DPNB-LM group (84.6%) and the DPNB-US group (91.4%) (both P < .001). DPNB-US demonstrated significant advantages over CEA and DPNB-LM in managing postoperative pain and intraoperative opioid requirements in obese pediatric circumcision patients. These findings support DPNB-US as a viable alternative in this vulnerable population.