I. Technique: Dorsal Penile Nerve Block (infants)

  1. Indications
    1. Neonatal Circumcision
  2. Preparation
    1. Using a 1 cc tuberculin syringe, draw up 1 cc of Lidocaine 1% without Epinephrine
    2. Attach a 30 gauge 1" needle to syringe
  3. Procedure
    1. Patient lies supine
    2. Assistant holds legs to sides
    3. Apply antiseptic to injection site (hibiclens or betadine)
    4. Insert needle at dorsal base of penis at 10:00 position
      1. Insert superficially and raise a small skin wheel
      2. Advance needle, directed toward midline to a depth of 5mm
      3. Aspirate to confirm not in vessel
      4. Deposit 0.4 ml of Lidocaine
    5. Withdraw needle
    6. Reinsert needle at 2:00 position and repeat techinque that was performed at the 10:00 position

II. Technique: Topical EMLA (adults)

  1. Indications
    1. Pre-anesthetic prior to local infiltration or Dorsal Penile Nerve Block
    2. Superficial procedure (e.g. Cryotherapy)
    3. Penile procedure in a patient with underlying Neuropathy (EMLA alon may be sufficient anesthesia)
  2. Apply EMLA to penile skin, local injection site or area of DPNB injection
  3. Cover penis with Condom
  4. Onset of action: 45 minutes

III. Technique: Local Anesthetic infiltration

  1. Indications
    1. Penile Laceration Repair
    2. Penile Zipper Entrapment
  2. Preparation
    1. Consider EMLA topical anesthetic first (see above)
    2. Using a 5cc syringe, draw up 3-5 cc of Lidocaine 1% without Epinephrine
    3. Attach a 30 gauge 1" needle to syringe
  3. Procedure
    1. Patient lies supine
    2. Apply antiseptic to injection site (hibiclens or betadine)
    3. Insert needle at either side of Laceration or injury site (repeat for opposite side)
      1. Raise a superficial wheel
      2. Aspirate and infiltrate Lidocaine subcutaneously

IV. Technique: Dorsal Penile Nerve Block (adults)

  1. Indications
    1. Extensive penile procedure
  2. Preparation
    1. Draw all 3 agents into 30 cc syringe and then apply 27 gauge, 1.25" needle
      1. Typical infiltrate 10-15 cc of mixed solution (less than half of that prepared)
    2. Anesthetic mix
      1. Bupivicaine 1% without Epinephrine 10 cc
      2. Lidocaine 1% with Epinephrine 10 cc
      3. Normal Saline 10 cc
  3. Procedure
    1. Patient lies supine
    2. Mark injection entry site at mid-pubic arch at base of penis
    3. Apply antiseptic to injection site (hibiclens or betadine)
    4. Insert needle, aspirate and inject at both sides of symphysis pubis
      1. Insert at mid-pubic arch perpendicular to skin until needle strikes symphysis pubis
      2. Withdraw a short distance and redirect needle laterally
        1. Angle to one side of the symphysis pubis
        2. Insert 3-5 mm deep to symphysis pubis
        3. Aspirate to confirm not in vessel and inject 5-7 cc of solution
      3. Withdraw needle without removing completely from skin
      4. Repeat injection, redirecting needle to the opposite side of the symphysis pubis
  4. Reference
    1. Circumcision under local anesthetic
      1. http://update.anaesthesiologists.org/wp-content/uploads/2009/09/Circumcision-under-Local-Anaesthetic.pdf

Images: Related links to external sites (from Google)

Ontology: nerve block dorsal penile (C2921974)

Concepts Therapeutic or Preventive Procedure (T061)
English nerve block dorsal penile, nerve block dorsal penile (treatment)