Ultrasound-Guided Dorsal Penile Nerve Block Reduces Perioperative Opioid Requirements in Pediatric Circumcision: A Systematic Review and Meta-Analysis.

AIM: This meta-analysis compares ultrasound-guided and landmark-based dorsal penile nerve block (DPNB) in pediatric circumcision.

METHODS

We systematically searched PubMed, Scopus, Web of Science, Embase, and Cochrane CENTRAL from inception to December 2025. Eligible studies included randomized controlled trials (RCTs) and observational cohorts comparing ultrasound-guided with landmark-based DPNB in pediatric patients (≤18 years) undergoing circumcision. Primary outcomes were intraoperative and postoperative opioid rescue requirements. Secondary outcomes included pain scores at incision, surgical duration, discharge time, and postoperative nausea/vomiting. Meta-analyses were performed using RStudio version 4.4.3.

RESULTS

Nine studies involving 949 children met inclusion criteria (five RCTs, four retrospective cohorts). Ultrasound-guided DPNB significantly reduced intraoperative opioid rescue (risk ratio 0.39, 0.18-0.88; p = 0.028) and postoperative opioid requirements (risk ratio 0.26, 0.07-0.94; p = 0.0442) compared with landmark-based techniques. No significant differences emerged in pain scores at incision, discharge time, or postoperative nausea/vomiting. Ultrasound-guided blocks required modestly longer procedural time (mean difference 1.48 min, 0.03-2.94; p = 0.048).

CONCLUSIONS

Ultrasound-guided DPNB substantially may reduce perioperative opioid requirements in pediatric circumcision compared with landmark-based approaches, despite slightly longer procedural times. When resources and expertise permit, ultrasound guidance should be considered the technique of choice for optimizing opioid-sparing anesthesia in this population.