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

Egypt performed circumcision in 2300 BC, although its origin is unknown. Some societies use circumcision for health, whereas others do it for religious and cultural reasons . Our competent pediatric surgeons perform circumcisions without ultrasonography using midazolam (0.1 mg/kg) premedication and penile block. In addition to penile block, general anesthesia is given using sevoflurane, ketamine, fentanyl, and propofol, depending on age and weight, for intraoperative anesthesia and analgesia. Penis procedures are frequently simple (phimosis, circumcision), but the pain is significant and long-lasting, affecting young patients' postoperative recovery. The topic of analgesia remains relevant and important in anesthesia practice. Early patient mobilization and discharge are crucial. Pediatric opioid use is questioned due to adverse effects include somnolence, vomiting, and respiratory depression. The advent of ultrasound-guided nerve blocks has revolutionized regional anesthesia in pediatrics. Many upper and lower abdominal operations use truncal blocks with good success and patient safety. Since its applicability, ease of anatomical approach, distance to the medulla spinalis and surgical site, and minimal risk of infection, sacral ESP block has become a popular method for youngsters. Postoperative pain trials demonstrate it works well.

\*\*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.