The safety of dorsal penile nerve block for neonatal circumcision

Dorsal penile nerve block (DPNB) was first described for use in neonatal circumcision in 1978. Since then, many studies have documented its effectiveness in alleviating pain in newborns undergoing circumcision. In 1989, the American Academy of Pediatrics acknowledged that DPNB may relieve the pain and stress of circumcision but stopped short of endorsing its routine use in this procedure, citing lack of data on its safety.

To determine the types and rates of complications from DPNB used for neonatal circumcision, the authors conducted a retrospective review of hospital records of 1358 circumcised male infants delivered at an urban medical center during a 1-year period.

Of the 1358 records reviewed, 1222 (90%) had sufficient documentation to be included in the study. DPNB was used in 1022 (84%) of the circumcisions. Complications occurred in 12 cases (11 with small ecchymoses at injection sites and one with excessive bleeding from the needle stick), for a rate of 1.2%. No cases of lidocaine toxicity, voiding delay, or vascular compromise were noted. There was a trend toward increased incidence of injection-site hematomas with the Plastibell as compared with the Gomco technique (P = .07). There were no significant differences in complication rates for DPNB performed by less experienced operators (eg, medical students and residents) compared with more experienced operators (staff physicians).

This study corroborates findings of smaller case studies, indicating that DPNB is associated with a low rate of minor complications.