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Background: There is a lack of consensus regarding post-operative pain management after penile surgery in children. Narcotic use in this age group is not without risks and may be administered unnecessarily in this patient population.
Methods: From November 2012 through April 2013 patients undergoing penile surgery in the outpatient setting were accrued for a prospective study to evaluate their post-operative analgesic requirements. Procedures performed were circumcision, circumcision revision, hypospadias, chordee, and lysis of penile adhesions. All patients were placed under general anesthesia and received either a caudal block or a penile block at the discretion of the anesthesiologist. All patients were discharged with Tylenol and narcotic postoperatively. Analgesic requirements (Tylenol, Motrin, or narcotic) were assessed at the 24 hour time point via telephone interview.
Results: A total of 95 boys met inclusion criteria. Patients were divided into two age groups: group 1= 0-12mo and group 2= > 12mo. Rate of caudal block in group 1 was 31/41 (76%) compared to 6/54 (11%) in group 2, while penile block was performed in 10/35 (29%) and 48/54 (89%) in each group, respectively. Rate of narcotic rescue was 0/41 (0%) in group 1, compared to 27/54 (50%) in group 2 (p=0.0001). Hypospadias repair was more common in group 1. No major complications were noted in either group, and there were no readmissions.

	Age 0-12 months	Narcotic requirement	Age >12 months	Narcotic requirement	p-value
Caudal block	31	0	6	2
Penile block	10	0	48	25
Total	41	0	54	27	<0.001

	0-12 months	>12 months
Surgery
Chordee	3	5
Hypospadias	12	4
Circumcision/circ revision	26	45

Conclusions: Boys less than 1 year of age undergoing penile surgery with regional block do not require post-operative narcotic analgesia. Patients older than 1 year of age have a near 50% rate of narcotic usage post-penile surgery. This study suggests that boys <1 year should not be discharged with narcotic prescription as their pain can be adequately controlled with Tylenol and Motrin.