Caudal epidural block versus other methods of postoperative pain relief for circumcision in boys

Allan M Cyna; Philippa Middleton

doi:10.1002/14651858.CD003005.pub2

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Analysis 1.1

Comparison 1 Caudal analgesia versus parenteral analgesia, Outcome 1 Need for analgesia.

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Analysis 1.2

Comparison 1 Caudal analgesia versus parenteral analgesia, Outcome 2 Nausea or vomiting.

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Analysis 2.1

Comparison 2 Caudal analgesia versus dorsal nerve penile block, Outcome 1 Need for any analgesia (rescue or other).

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Analysis 2.2

Comparison 2 Caudal analgesia versus dorsal nerve penile block, Outcome 2 Need for rescue analgesia.

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Analysis 2.3

Comparison 2 Caudal analgesia versus dorsal nerve penile block, Outcome 3 Other analgesia.

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Analysis 2.4

Comparison 2 Caudal analgesia versus dorsal nerve penile block, Outcome 4 Pain score.

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Analysis 2.5

Comparison 2 Caudal analgesia versus dorsal nerve penile block, Outcome 5 Complications.

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Analysis 2.6

Comparison 2 Caudal analgesia versus dorsal nerve penile block, Outcome 6 Time to discharge home (mins).

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Analysis 2.7

Comparison 2 Caudal analgesia versus dorsal nerve penile block, Outcome 7 Parental satisfaction.

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Analysis 2.8

Comparison 2 Caudal analgesia versus dorsal nerve penile block, Outcome 8 Procedural time (mins).

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Study	Caudal (mean) mins	Caudal (range), mins	DNBP (mean) mins	DNBP (range) mins	p value
recovery room stay
Mak 2001	15.2 (n=63)	10‐30	15.5 (n=63)	(10‐25)	pns

Analysis 2.9

Comparison 2 Caudal analgesia versus dorsal nerve penile block, Outcome 9 Hospital stay.

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Analysis 3.1

Comparison 3 Caudal analgesia versus rectal or intravenous, Outcome 1 Need for any analgesia (rescue or other).

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Analysis 3.2

Comparison 3 Caudal analgesia versus rectal or intravenous, Outcome 2 Need for rescue analgesia.

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Analysis 3.3

Comparison 3 Caudal analgesia versus rectal or intravenous, Outcome 3 Other analgesia.

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Analysis 3.4

Comparison 3 Caudal analgesia versus rectal or intravenous, Outcome 4 Complications.

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Study	caudal (mean) mins	caudal (range) mins	rect/i.v. (mean) min	rect/i.v. (range) mi	p value
recovery room stay
Mak 2001	15.2 (n=61)	10‐30	14.6 (n=61)	10‐25	pns

Analysis 3.5

Comparison 3 Caudal analgesia versus rectal or intravenous, Outcome 5 Hospital stay.

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Comparison 1. Caudal analgesia versus parenteral analgesia

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Need for analgesia Show forest plot	4		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

1.1 need for any analgesia (rescue or other)	4	235	Risk Ratio (M‐H, Random, 95% CI)	0.41 [0.12, 1.43]
1.2 need for rescue analgesia	2	131	Risk Ratio (M‐H, Random, 95% CI)	0.52 [0.05, 5.72]
1.3 other analgesia	2	104	Risk Ratio (M‐H, Random, 95% CI)	0.54 [0.04, 6.88]
2 Nausea or vomiting Show forest plot	4	235	Risk Ratio (M‐H, Fixed, 95% CI)	0.61 [0.36, 1.05]

Comparison 1. Caudal analgesia versus parenteral analgesia

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Comparison 2. Caudal analgesia versus dorsal nerve penile block

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Need for any analgesia (rescue or other) Show forest plot	4	336	Risk Ratio (M‐H, Random, 95% CI)	1.25 [0.64, 2.44]

2 Need for rescue analgesia Show forest plot	4	336	Risk Ratio (M‐H, Fixed, 95% CI)	2.71 [0.81, 9.09]

3 Other analgesia Show forest plot	2		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

3.1 paracetamol up to 2 hours postop	1	126	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 8.03]
3.2 paracetamol on day of operation	1	126	Risk Ratio (M‐H, Fixed, 95% CI)	0.92 [0.68, 1.24]
3.3 paracetamol at home	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	1.67 [0.66, 4.24]
4 Pain score Show forest plot	1	100	Mean Difference (IV, Fixed, 95% CI)	0.5 [‐0.17, 1.17]

5 Complications Show forest plot	5		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

5.1 nausea and vomiting	4	336	Risk Ratio (M‐H, Random, 95% CI)	1.88 [0.70, 5.04]
5.2 motor block	1	100	Risk Ratio (M‐H, Random, 95% CI)	17.0 [1.01, 286.82]
5.3 motor/leg weakness	2	110	Risk Ratio (M‐H, Random, 95% CI)	10.07 [1.25, 81.32]
5.4 bleeding	1	126	Risk Ratio (M‐H, Random, 95% CI)	1.0 [0.06, 15.64]
5.5 bruising of skin/at needle site	3	274	Risk Ratio (M‐H, Random, 95% CI)	0.34 [0.07, 1.82]
5.6 tachycardia	1	100	Risk Ratio (M‐H, Random, 95% CI)	2.0 [0.53, 7.56]
5.7 phonation	1	100	Risk Ratio (M‐H, Random, 95% CI)	3.00 [0.32, 27.87]
5.8 movement	1	100	Risk Ratio (M‐H, Random, 95% CI)	0.20 [0.01, 4.06]
5.9 eating disturbance	1	57	Risk Ratio (M‐H, Random, 95% CI)	0.89 [0.27, 2.97]
5.10 sleep disturbance	1	57	Risk Ratio (M‐H, Random, 95% CI)	1.30 [0.73, 2.29]
5.11 behavioural disturbance	1	57	Risk Ratio (M‐H, Random, 95% CI)	0.91 [0.45, 1.85]
5.12 urinary retention	1	57	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
6 Time to discharge home (mins) Show forest plot	1	100	Mean Difference (IV, Fixed, 95% CI)	37.0 [18.97, 55.03]

7 Parental satisfaction Show forest plot	1	100	Mean Difference (IV, Fixed, 95% CI)	‐0.10 [‐0.58, 0.38]

8 Procedural time (mins) Show forest plot	1	100	Mean Difference (IV, Fixed, 95% CI)	1.90 [1.33, 2.47]

9 Hospital stay Show forest plot			Other data	No numeric data

9.1 recovery room stay			Other data	No numeric data

Comparison 2. Caudal analgesia versus dorsal nerve penile block

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Comparison 3. Caudal analgesia versus rectal or intravenous

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Need for any analgesia (rescue or other) Show forest plot	2	164	Risk Ratio (M‐H, Random, 95% CI)	0.81 [0.51, 1.27]

2 Need for rescue analgesia Show forest plot	1	124	Risk Ratio (M‐H, Fixed, 95% CI)	4.84 [0.24, 98.88]

3 Other analgesia Show forest plot	2		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

3.1 acetaminophen before discharge	1	40	Risk Ratio (M‐H, Fixed, 95% CI)	0.6 [0.35, 1.04]
3.2 paracetamol up to 2 hours postop	1	124	Risk Ratio (M‐H, Fixed, 95% CI)	0.19 [0.01, 3.96]
3.3 paracetamol on day of operation	1	124	Risk Ratio (M‐H, Fixed, 95% CI)	1.03 [0.75, 1.41]
4 Complications Show forest plot	2		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

4.1 nausea and vomiting	2	164	Risk Ratio (M‐H, Random, 95% CI)	0.88 [0.14, 5.53]
4.2 bleeding	1	124	Risk Ratio (M‐H, Random, 95% CI)	0.97 [0.06, 15.14]
4.3 bruising of skin/at needle site	1	124	Risk Ratio (M‐H, Random, 95% CI)	2.91 [0.12, 69.99]
5 Hospital stay Show forest plot			Other data	No numeric data

5.1 recovery room stay			Other data	No numeric data

Comparison 3. Caudal analgesia versus rectal or intravenous

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