Does dorsal penile block reduce the FLACC score in cases who underwent circumcision under ketamine–propofol sedation in children?

Vildan Kölükçü; Yunus Emre Kuyucu; Kenan Yalçın; Hüseyin Biçer

Does dorsal penile block reduce the FLACC score in cases who underwent circumcision under ketamine–propofol sedation in children?

Abstract

Aims: This study aimed to evaluate the effect of dorsal penile block on postoperative Face, Legs, Activity, Cry and Consolability (FLACC) score in children undergoing circumcision under ketamine–propofol sedation. Methods: The data of 115 children aged 7-9 years who underwent circumcision under ketamine-propofol sedation were retrospectively analyzed. Patients were categorized into two groups: those who received a dorsal penile block (group 2) and those who did not (group 1). Demographic characteristics, FLACC score, analgesic requirements, operation duration, recovery unit time, intraoperative mean heart rate, oxygen saturation measurements, and time to first micturition were analyzed in both groups. Results: The mean age of the children was 7.77±0.78 years, and no significant difference in age distribution was observed between the groups (p>0.05). Similarly, operation duration, intraoperative heart rate, oxygen saturation measurements, and recovery unit time were comparable between the groups (p>0.05). In group 1, 17 patients (28.3%) had analgesic requirements, and the mean FLACC score was 4.02±1.90. Analgesic requirements and FLACC scores were significantly higher in group 1 compared with group 2 (p=0.017 and p<0.001, respectively). Likewise, time to the first analgesic requirement was significantly longer in group 2 (p<0.001). All patients were discharged on the day of surgery and the time to first micturition was less than 6 hours in both groups (p>0.05). Conclusion: Our findings demonstrate that the use of dorsal penile nerve block during circumcision under ketamine-propofol sedation significantly reduces FLACC score and analgesic requirements.

Keywords

Supporting Institution

---

Ethical Statement

The study was approved by the Local Ethics Committee of Tokat Gaziosmanpaşa University (Approval No: 26 MOBAEK-074, Date: March 2026).

Thanks

---

References

Akyüz O, Çoban S, Bodakçı MN, Demir M, Özdemir AA. Every aspect of circumcision regarding contemporary literature. New J Urol. 2018; 13(2):70-76.
Aydemir H, Gökçe A. Sünnetin ejakülasyon kontrolü üzerine etkileri. Androl Bul. 2016;18(64):1-3.
Karaman İ, Öztürk M, Koca O. Sünnet komplikasyonları (Derleme). Androl Bul. 2013;15(53):75-78.
Morris BJ, Wamai RG, Henebeng EB, et al. Estimation of country-specific and global prevalence of male circumcision. Popul Health Metr. 2016;14:4. doi:10.1186/s12963-016-0073-5
Nonnemacher C, Saylors S, Elman M, Taylor C, Glenski T, Oyetunji TA. Caudal block with intravenous sedation and natural airway provides adequate anesthesia and analgesia for circumcision in young patients. Am Surg. 2026;92(1):99-103. doi:10.1177/00031348251356741
Çimke S, Aras NF. Impact of video games during circumcision on children's pain, anxiety, and physiological responses: a quasi-experimental study. J Pediatr Nurs. 2025;85:151-156. doi:10.1016/j.pedn.2025.07.020
Kilani RA. Improving pain score and restraint duration during circumcision. J Family Med Prim Care. 2025;14(4):1174-1178. doi:10.4103/jfmpc.jfmpc_852_24
Görgel SN, Tol BE. The impact of the application of a penile block before circumcision on the postoperative FLACC score and analgesic requirement. Turk J Urol. 2013;39(1):39-42. doi:10.5152/tud.2013.008

Merkel SI, Voepel-Lewis T, Shayevitz JR, Malviya S. The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr Nurs. 1997;23(3):293-297.
Doğan AK, Avcı O, Kuguoglu S. Turkish validity and reliability study of the pediatric comfort assessment scale. EGEHFD. 2025;41(1):136-146. doi:10.53490/egehemsire.1260623
Şenaylı Y, Özkan F, Şenaylı A, Bıçakçı Ü. Evaluation of postoperative pain in children with FLACC pain scale in Turkish translation. Turkiye Klinikleri J Anest Reanim. 2006;4(1):1-4.
Sezer TA, Esenay FI, Korkmaz G. Postoperative pain scale in preschool children: validity and reliability of Turkish. J Curr Pediatr. 2021;19:84-91. doi:10.4274/jcp.2021.0012
Özdeş AA, Korhan Z, Beler M, Cantürk R, Ozan T. Sedation-only anesthesia for pediatric circumcision: a safer alternative. Niger J Clin Pract. 2025;28(9):1004-1009. doi:10.4103/njcp.njcp_437_25
Yalçın K. Our results of dorsal slit method in children applied with circumcision. Androl Bul. 2023;25:1-5. doi:10.24898/tandro.2023.34445
Labban M, Menhem Z, Bandali T, Hneiny L, Zaghal A. Pain control in neonatal male circumcision: a best evidence review. J Pediatr Urol. 2021; 17(1):3-8. doi:10.1016/j.jpurol.2020.09.017
Gulec H, Sahin S, Ozayar E, Degerli S, Bercin F, Ozdemir O. Ketamine-propofol sedation in circumcision. Braz J Anesthesiol. 2015;65(5):367-70. doi:10.1016/j.bjane.2014.03.002
Kölükçü V, Balta MG, Tapar H, , et al. Effects of ketamine on penile tissues in an experimental priapism model in rats. Ulus Travma Acil Cerrahi Derg. 2024;30(5):309-315. doi:10.14744/tjtes.2024.33262
Daud YN, Carlson DW. Pediatric sedation. Pediatr Clin North Am. 2014; 61(4):703-717. doi:10.1016/j.pcl.2014.05.003.
Lundström S, Twycross R, Mihalyo M, Wilcock A. Propofol. J Pain Symptom Manage. 2010;40(3):466-470. doi:10.1016/j.jpainsymman.2010.07.001
Shah A, Mosdossy G, McLeod S, Lehnhardt K, Peddle M, Rieder M. A blinded, randomized controlled trial to evaluate ketamine/propofol versus ketamine alone for procedural sedation in children. Ann Emerg Med. 2011;57(5):425-433. doi:10.1016/j.annemergmed.2010.08.032
Akin A, Esmaoglu A, Guler G, Demircioglu R, Narin N, Boyaci A. Propofol and propofol-ketamine in pediatric patients undergoing cardiac catheterization. Pediatr Cardiol. 2005;26(5):553-557. doi:10.1007/s00246-004-0707-4
Akin A, Esmaoglu A, Tosun Z, Gulcu N, Aydogan H, Boyaci A. Comparison of propofol with propofol-ketamine combination in pediatric patients undergoing auditory brainstem response testing. Int J Pediatr Otorhinolaryngol. 2005;69(11):1541-1545. doi:10.1016/j.ijporl.2005.04.011
Turgut H, Özdemir A. Evaluation Of analgesia efficiency of additional local anesthesia during the circumcision procedure. New J Urol. 2019; 14(2):114-118. doi:10.33719/yud.582719
Ozan T. Comparison of applied aneshesia techniques in terms of postoperative pain status by circumsion procedure: a single urologists’ experience. F Ü Sağ Bil Tıp Derg. 2025;39(1):68-72.
Gauntlett I. A comparison between local anaesthetic dorsal nerve block and caudal bupivacaine with ketamine for paediatric circumcision. Paediatr Anaesth. 2003;13(1):38-42. doi:10.1046/j.1460-9592.2003.00926.x
López-Maya L, Lina-Manjarrez F, Fuentes-Ramos F, Espíndola-Flores BF, Lina-López LM. Manejo anestésico para circuncisión en niños: bloqueo del nervio dorsal del pene versus anestesia general. Revista Mexicana de Anestesiología. 2009;32(4):239-246.
Serour F, Reuben S, Ezra S. Circumcision in children with penile block alone. J Urol. 1995;153(2):474-476. doi:10.1097/00005392-199502000-00062
Serour F, Cohen A, Mandelberg A, Mori J, Ezra S. Dorsal penile nerve block in children undergoing circumcision in a day-care surgery. Can J Anaesth. 1996;43(9):954-958. doi:10.1007/BF03011810
Perlmutter DF, Lawrence JM, Krauss AN, Auld PA. Voiding after neonatal circumcision. Pediatrics. 1995;96(6):1111-1112.
Narchi H, Kulaylat N. Neonatal circumcision: when can infants reliably be expected to void? Pediatrics. 1998;102(1):150-152. doi:10.1542/peds.102.1.150
Sarı H, Ekenci BY, Durak HM, Keskin G, Doğan AE, Sağnak AL. Comparison of penile block and caudal block applications in patients undergoing circumcision surgery. J Urol Surg. 2024;11(1):25-29. doi:10.4274/jus.galenos.2023.2023-5-13
Gauntlett I. A comparison between local anaesthetic dorsal nerve block and caudal bupivacaine with ketamine for paediatric circumcision. Paediatric Anaesthesia. 2003;13:38-42.
Çikme S. Determination of childrens emotional stress after circumcion. DEU Med. 2023;37(1):59-66 doi:10.18614/deutip.1177362
Yavuz M, Demir T, Doğangün B. Sünnetin çocuk ruh sağlığı üzerine etkisi: gözden geçirme çalışması. Türk Psikiyatri Derg. 2012;23(1):63-70.

Details

Primary Language

English

Subjects

Anaesthesiology

Journal Section

Research Article

Authors

Vildan Kölükçü ^*
0000-0002-3914-3899
Türkiye

Yunus Emre Kuyucu
0000-0001-8808-1287
Türkiye

Kenan Yalçın
0000-0003-3560-5862
Türkiye

Hüseyin Biçer
0000-0001-7703-3618
Türkiye

Publication Date

June 25, 2026

Submission Date

April 21, 2026

Acceptance Date

May 25, 2026

Published in Issue

Year 2026 Volume: 7 Number: 3

IZ

https://izlik.org/JA42CH39EM

Cite

RIS / Bibtex

APA

Kölükçü, V., Kuyucu, Y. E., Yalçın, K., & Biçer, H. (2026). Does dorsal penile block reduce the FLACC score in cases who underwent circumcision under ketamine–propofol sedation in children? Journal of Medicine and Palliative Care, 7(3), 514-519. https://izlik.org/JA42CH39EM

AMA

1.Kölükçü V, Kuyucu YE, Yalçın K, Biçer H. Does dorsal penile block reduce the FLACC score in cases who underwent circumcision under ketamine–propofol sedation in children? J Med Palliat Care / JOMPAC / jompac. 2026;7(3):514-519. https://izlik.org/JA42CH39EM

Chicago

Kölükçü, Vildan, Yunus Emre Kuyucu, Kenan Yalçın, and Hüseyin Biçer. 2026. “Does Dorsal Penile Block Reduce the FLACC Score in Cases Who Underwent Circumcision under Ketamine–propofol Sedation in Children?”. Journal of Medicine and Palliative Care 7 (3): 514-19. https://izlik.org/JA42CH39EM.

EndNote

Kölükçü V, Kuyucu YE, Yalçın K, Biçer H (June 1, 2026) Does dorsal penile block reduce the FLACC score in cases who underwent circumcision under ketamine–propofol sedation in children? Journal of Medicine and Palliative Care 7 3 514–519.

IEEE

[1]V. Kölükçü, Y. E. Kuyucu, K. Yalçın, and H. Biçer, “Does dorsal penile block reduce the FLACC score in cases who underwent circumcision under ketamine–propofol sedation in children?”, J Med Palliat Care / JOMPAC / jompac, vol. 7, no. 3, pp. 514–519, June 2026, [Online]. Available: https://izlik.org/JA42CH39EM

ISNAD

Kölükçü, Vildan - Kuyucu, Yunus Emre - Yalçın, Kenan - Biçer, Hüseyin. “Does Dorsal Penile Block Reduce the FLACC Score in Cases Who Underwent Circumcision under Ketamine–propofol Sedation in Children?”. Journal of Medicine and Palliative Care 7/3 (June 1, 2026): 514-519. https://izlik.org/JA42CH39EM.

JAMA

1.Kölükçü V, Kuyucu YE, Yalçın K, Biçer H. Does dorsal penile block reduce the FLACC score in cases who underwent circumcision under ketamine–propofol sedation in children? J Med Palliat Care / JOMPAC / jompac. 2026;7:514–519.

MLA

Kölükçü, Vildan, et al. “Does Dorsal Penile Block Reduce the FLACC Score in Cases Who Underwent Circumcision under Ketamine–propofol Sedation in Children?”. Journal of Medicine and Palliative Care, vol. 7, no. 3, June 2026, pp. 514-9, https://izlik.org/JA42CH39EM.

Vancouver

1.Vildan Kölükçü, Yunus Emre Kuyucu, Kenan Yalçın, Hüseyin Biçer. Does dorsal penile block reduce the FLACC score in cases who underwent circumcision under ketamine–propofol sedation in children? J Med Palliat Care / JOMPAC / jompac [Internet]. 2026 Jun. 1;7(3):514-9. Available from: https://izlik.org/JA42CH39EM