Critical urologic skills and procedures in the emergency department

Evaluation of the Postoperative Analgesic Effect of 2 Different Blocks after Pediatric Circumcision Surgery

BACKGROUND

Circumcision is a painful day-case surgery. Regional anesthesia techniques are used effectively for anesthesia and postoperative analgesia after pediatric circumcision surgery.

OBJECTIVE

Our prospective observational study aimed to compare postoperative analgesic efficiency of a dorsal penile nerve (DPN) block with a transversus abdominis plane (TAP) block after male pediatric circumcision surgery and complications related to each block.

STUDY DESIGN

We enrolled 80 male children under the age of 10 years with American Society of Anesthesiologists I-II status scheduled for circumcision in this prospective observational study. A TAP or DPN block was performed after induction of general anesthesia before surgery with ultrasound (US) guidance. Postoperative pain was assessed with Faces Pain Scale-Revised and the Faces, Legs, Activity, Cry and Consolability scale.

RESULTS

There was no statistically significant difference between the groups regarding 30-min pain score levels (p > 0.05). But, the 1st hour, 2nd hour, 6th hour, 12th hour, and 24th-hour pain score levels in the TAP block group were statistically significantly higher than those of the DPN block group (p < 0.05). The 1st rescue analgesic requirement in the TAP block group was at the 6th hour postoperative. There was no need for rescue analgesia in the DPN block group during the postoperative 24-h follow-up.

DISCUSSION

A US-guided DPN block provided effective and long-lasting postoperative analgesia for circumcision surgery with statistically significantly lower pain score levels than a US-guided TAP block.

CONCLUSION

This study found that a TAP block alone was insufficient to provide adequate postoperative analgesia for circumcision surgery compared to DPN block.

A rare complication of suprapubic catheterisation with obstruction and significant migration into a ureter

Suprapubic catheter insertion is frequently indicated for patients with a neurogenic bladder. It's an effective and safe way to drain the bladder and can be managed in a community setting by a trained health professional. Here we report a rare case of a 73-year-old male-presenting with a two-day history of frank haematuria secondary to a recent suprapubic catheter change. Imaging confirmed an obstruction of the right ureteric orifice due to migration of the catheter into the ureter. Once the catheter was withdrawn into the correct location his haematuria and acute renal injury resolved and was discharged the following day.

A Systematic Review of the World of Validated Suprapubic Catheter Insertion Simulation Trainers: From 'Head-Blocks' to 'Lunch Boxes'

PURPOSE

Various suprapubic catheter insertion simulators have been described to aid in the training of this fundamental skill. The purpose of this review was to evaluate and critically appraise all validated simulators.

METHODS

The PubMed, Web of Science, Cochrane Library, Scopus, British Medical Journal and the Embase databases were searched (March 2018), by using key search terms "suprapubic trainer", "suprapubic model", "suprapubic simulation" and "suprapubic simulator".

RESULTS

A total of 196 articles were identified; 117 unrelated, 53 animal studies and 20 duplications. Only 6 articles met the inclusion criteria for this review. The median number of participants per study was 30.5. Material costs ranged from 1.71 to 60 dollars per model. Only 2 studies incorporated the use of ultrasound.

CONCLUSION

Despite validated suprapubic catheter insertion models being a specially needed learning resource, only few have been described-mostly for not resourceful environments. There exists a general lack of guidelines on model validation processes. There is a need to develop, appropriately validate and integrate models into training curriculum.