{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T21:58:35Z","timestamp":1790891915884,"version":"4.1.0"},"reference-count":26,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2018,7,23]],"date-time":"2018-07-23T00:00:00Z","timestamp":1532304000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2018,8]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background and aims<\/jats:title><jats:p>Circumcision is a frequently performed procedure in day case pediatric surgery. Dorsal penile nerve block has proven its effectiveness for the management of acute postoperative pain after circumcision. We investigated if the ultrasound\u2010guided placement of a dorsal penile nerve block could reduce opioid requirement as compared to a landmark\u2010based technique.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Three hundred and ten prepubertal children, aged between 52\u00a0weeks postconception and 11\u00a0years, were included in this prospective, observer\u2010blinded, randomized controlled trial and received either a landmark\u2010 or an ultrasound\u2010guided dorsal penile nerve block, using a caudal needle and injecting 0.1\u00a0<jats:styled-content style=\"fixed-case\">mL<\/jats:styled-content>\/kg levobupivacaine 0.5% bilaterally. A single, experienced investigator performed all blocks. The primary endpoint was the number of patients in need of piritramide postoperatively as triggered by the Objective Pain Scale. Secondary outcome parameters included the cumulative dose of postoperatively administered opioids, the requirement to administer fentanyl intraoperatively, the need for paracetamol and ibuprofen during the first 24 postoperative hours, postoperative pain scores, the incidence of postoperative nausea and vomiting, the anesthesia induction time, and the time to discharge.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The proportion of patients requiring postoperative piritramide did not differ significantly between both groups (Landmark: 38% vs Ultrasound: 47%, with a difference in proportion between both conditions (95% CI): 0.09 (0.2 to 0.02); <jats:italic>P<\/jats:italic>\u00a0=\u00a0.135). In addition, the cumulative doses of postoperative piritramide and intraoperative fentanyl, the postoperative need for paracetamol or ibuprofen, pain scores, the incidence of postoperative nausea and vomiting, and the time to discharge were not different either. However, the anesthesia induction time was significantly longer in the ultrasound\u2010guided dorsal penile nerve block (median time [<jats:styled-content style=\"fixed-case\">IQR<\/jats:styled-content>]: Landmark: 11[9; 13] min vs Ultrasound: 13[11; 15] min, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Compared with the landmark\u2010guided, the ultrasound\u2010guided dorsal penile nerve block did not reduce the need for postoperative analgesia after circumcision in children, but was associated with an increase in the procedural time.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pan.13429","type":"journal-article","created":{"date-parts":[[2018,7,23]],"date-time":"2018-07-23T09:59:24Z","timestamp":1532339964000},"page":"703-709","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Dorsal penile nerve block for circumcision in pediatric patients: A prospective, observer\u2010blinded, randomized controlled clinical trial for the comparison of ultrasound\u2010guided vs landmark technique"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6279-7436","authenticated-orcid":false,"given":"An","family":"Teunkens","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology University Hospitals of the KU Leuven Leuven Belgium"},{"name":"Department of Cardiovascular Sciences KU Leuven\u2010University of Leuven Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Van de Velde","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology University Hospitals of the KU Leuven Leuven Belgium"},{"name":"Department of Cardiovascular Sciences KU Leuven\u2010University of Leuven Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristien","family":"Vermeulen","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology University Hospitals of the KU Leuven Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe","family":"Van Loon","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology University Hospitals of the KU Leuven Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guy","family":"Bogaert","sequence":"additional","affiliation":[{"name":"Department of Urology University Hospitals of the KU Leuven Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steffen","family":"Fieuws","sequence":"additional","affiliation":[{"name":"I\u2010Biostat KU Leuven\u2010 University of Leuven Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steffen","family":"Rex","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology University Hospitals of the KU Leuven Leuven Belgium"},{"name":"Department of Cardiovascular Sciences KU Leuven\u2010University of Leuven Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,7,23]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/1824-7288-39-38"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.2165\/00128072-200103020-00003"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/00004703-198410000-00004"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.3344\/kjp.2011.24.1.31"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD003005.pub2"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1460-9592.2003.01033.x"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1213\/00000539-198907000-00008"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/0310057X0703500217"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1460-9592.2010.03405.x"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.2165\/11203250-000000000-00000"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-198706000-00023"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.3928\/19382359-20170921-03"},{"key":"e_1_2_10_14_1","doi-asserted-by":"crossref","unstructured":"HinrichsM WeylandA BantelC.[Piritramide : A\u00a0critical review]. 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