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Optimal regional anesthesia for circumcision

F Serour1, J Mori, J Barr

  • 1Division of Pediatric Surgery, E. Wolfson Medical Center, Holon, Israel.

Anesthesia and Analgesia
|July 1, 1994
PubMed
Summary
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Adding perineal nerve block to dorsal penile nerve block (DPNB) significantly improves analgesia during circumcision. This combined approach reduces pain and the need for supplemental anesthesia, enhancing patient comfort.

Area of Science:

  • Urology
  • Anesthesiology
  • Surgical Procedures

Background:

  • Dorsal penile nerve block (DPNB) is a standard analgesic technique for circumcision.
  • DPNB has a reported failure rate of 4-6.7% for intraoperative pain management.
  • The role of perineal nerve innervation during circumcision is not fully elucidated.

Purpose of the Study:

  • To evaluate the intraoperative efficacy of adding perineal nerve block to DPNB during adult circumcision.
  • To compare pain incidence and the need for supplemental analgesia between DPNB alone and combined DPNB with perineal nerve block.

Main Methods:

  • Prospective, randomized, double-blind study involving 250 adult patients undergoing circumcision.
  • Patients were randomized to receive either DPNB (Group I) or DPNB with an additional ventral injection for perineal nerve analgesia (Group II).

Related Experiment Videos

  • The subpubic space technique was used for DPNB.

    • Main Results:

    • The failure rate for DPNB alone was 6.4%, with 13.6% of patients experiencing pain requiring supplemental analgesia.
    • In the combined group (DPNB + perineal nerve block), only 4% experienced mild discomfort, with no need for additional anesthesia (P < 0.01).
    • Average operative time was significantly shorter in the combined group (10.7 min) compared to DPNB alone (12.4 min) (P < 0.001).

    Conclusions:

    • Perineal nerves are crucial for penile innervation during circumcision and should be anesthetized.
    • Combining perineal nerve block with DPNB offers superior intraoperative analgesia and reduces the need for supplemental anesthesia.
    • This enhanced block technique improves patient comfort and potentially shortens surgical duration.