Comparison of the Effects of Sacral Erector Spinae Plane Block and Dorsal Penile Block on Postoperative Pain in Circumcision Procedures

Although it is not known exactly where it was first performed, there is evidence that the Egyptians performed circumcision in 2300 BC. While circumcision is performed for health reasons in some societies, it is a traditional, religious and cultural practice in some. In our clinic, circumcision cases are performed with anesthesia monitoring and premedication with midazolam (0.1 mg/kg) followed by penile block, which is our clinical practice, by experienced pediatric surgeons who perform the surgical procedure without the use of ultrasound. In addition to penile block in standard practice, general anesthesia is applied to patients with sevoflurane, ketamine, fentanyl and propofol, depending on the patient's age and weight, depending on the need for intraoperative anesthesia and analgesia. Postoperative pain after surgeries on the penis is a problem that directly affects postoperative recovery in young patients because the surgical procedure itself is often minor (treatment of phimosis, circumcision), whereas the pain produced is both severe and long-lasting.

The need for analgesia is a topic that always occupies anesthesia practice and maintains its relevance. It is vital to ensure early mobilization and discharge of patients. Many side effects, including somnolence, vomiting and respiratory depression, call into question the use of opioids in pediatrics.

Today, the use of ultrasound-guided nerve block has resulted in a revolutionary change in the field of regional anesthesia in pediatrics. Many truncal blocks are used with a high success rate in both upper and lower abdominal surgeries and have become standard in terms of patient safety.

Sacral ESP block, especially applied in children, has become an increasingly important technique due to its advantages such as applicability, ease of anatomical approach, distance to the medulla spinalis and surgical site, and low risk of infection. In addition, studies have shown that it is quite effective in postoperative pain.

**Inclusion Criteria:**

• Age 7 to 12 years.
• American Society of Anesthesiologists (ASA) Physical Status I or II.
• Scheduled to undergo elective circumcision under general anesthesia.
• Ability to communicate pain using the study pain assessment tools.
• Written informed consent obtained from a parent or legal guardian.

**Exclusion Criteria:**

• Refusal or inability of the parent/legal guardian or participant (when appropriate) to provide informed consent or assent.
• American Society of Anesthesiologists (ASA) Physical Status III or higher.
• Emergency surgery.
• History of significant hematologic, cardiovascular, hepatic, or renal disease.
• Current anticoagulant therapy.
• Known hypersensitivity or allergy to local anesthetic agents.
• Previous penile surgery.
• Any condition that, in the investigator's judgment, would interfere with study participation or outcome assessment.