Ultrasound-guided dorsal penile nerve block reduces intraoperative and postoperative opioid requirements in pediatric circumcisionUltrasound Guidance Reduces Opioid Needs During Pediatric Circumcision

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;  = 0.028) and postoperative opioid requirements (risk ratio 0.26, 0.07-0.94;  = 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;  = 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.