[Management of intraoperative erection by penile block]

Erection during endoscopic or penile surgery is a troublesome event. In this case report, the erection was first treated with intracavernous injection of etilefrine (8 mg) and detumescence was obtained rapidly. However, one hour later, the erection occurred again. Therefore a dorsal penile nerve block was performed by the median route, using 8 mL of 0.25% bupivacaine injected into the subpubic space. Mechanisms and treatments of intraoperative erections are discussed. Repeated intracavernous injections of vasoactive drugs may be dangerous, whereas a penile nerve block carries a lower risk of cardiovascular complications and provides an improved postoperative analgesia.