Dorsal penile nerve block is used for providing local anesthesia to penis.
Penile local anesthesia is used in various procedures like release of paraphimosis, dorsal slit of the foreskin, circumcision and repair of penile lacerations.
Just to mention, the ring penile block is different and usesse a 27-gauge needle to circumferentially infiltrate local anesthetic around the penis.
The penis is innervated by the pudendal nerve (S2-S4). This nerve eventually divides into the right and left dorsal nerves of the penis. These two nerves go under the pubis symphysis to travel just below the Buck fascia to supply the sensory innervation to the penis. Buck’s fascia is deep fascia of the penis covering the three erectile bodies of the penis.
The penile shaft is composed of 3 erectile columns. The two corpora cavernosa and the corpus spongiosum. Along are the columns enveloping fascial layers, nerves, lymphatics, and blood vessels.
There are two suspensory ligaments that support the penis at its base.
Indications for Dorsal Penile Nerve Block
- Slitting of foreskin [dorsal slit of the foreskin]
- Phimosis/Paraphimosis reduction
- Repair of penile wounds
- Release of penile skin entrapped in zippers
- Suspected testicular torsion
- Skin infection at the site of injection
Procedure of Dorsal Penile Nerve Block
Application of local topical anesthetic cream is recommended for all procedures. Some authors recommend systemic analgesia before the block with or without sedation.
For penile block the right and left dorsal penile nerves should be blocked as proximally to the base of the penis as possible.
- Patient is to lie supine with his genitalia exposed.
- Clean and prepare the part with povidone iodine solution
- Drape the region in sterile drapes leaving the desired area exposed.
- Use a 27-gauge needle to raise skin wheals at the 2- and 10-o’clock positions
- Slowly insert the needle through the center of each skin wheal directing it to the center of the shaft, to a depth of about 0.5 cm or until loss of resistance is felt. Loss of resistance suggests needle to be in Buck’s fascia
- Aspirate to ensure that the needle is not in a blood vessel, and slowly inject about 2 mL of local anesthetic on each side. [without epinephrine only. Epinephrine causes penile ischemia and necrosis.]
- In neonates and children use
- 0.2-0.4 mL of lidocaine 1%
- 30-gauge needle.
An alternative method has been described which involves injecting 2 mL of local anesthetic on either side of the midline.
Complications of Dorsal Penile Nerve Block
- Failure to achieve anesthesia – Repeat the block
- Soh CR, Ng SB, Lim SL. Dorsal penile nerve block. Paediatr Anaesth. 2003 May. 13(4):329-33.
- Abaci A, Makay B, Unsal E, Mustafa O, Aktug T. An unusual complication of dorsal penile nerve block for circumcision. Paediatr Anaesth. 2006 Oct. 16(10):1094-5..
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