Ultrasound guided in-plane penile nerve block for circumcision: A new, modified technique suggests lower anesthetic volume and narcotic use

Context: Circumcision is one of the most common surgical procedures in pediatric males. Anesthesia is often the classic dorsal penile nerve block (DPNB), which is based on landmark identification and tactile feel of tissue resistance during needle advancement. However, this technique is associated with technical failures and vascular complications. Objective: We used an ultrasound-guided in-plane technique to avoid injury of penile vascular and neural tissues during DPNB. The aims of this retrospective study were to compare the success rate and efficacy of these two penile block techniques. Methods: Male pediatric patients undergoing circumcision received general anesthesia before the penis and surrounding area were prepared with 0.5% chlorhexidine in 70% alcohol. Sixteen patients underwent classic DPNB, and 16 underwent the modified ultrasound-guided inplane technique. The ultrasound machine was adjusted to the musculoskeletal setting, and a linear ultrasound probe with a frequency range of 5 to 10 MHz was placed transversely along the base of the penis, which received gentle traction. Results: Though not statistically significant, patients who underwent the classic DPNB were approximately 1.8 times more likely to require rescue analgesia and approximately 2 times more likely to have a complication than those in the ultrasound-guided group. Results also showed lower volume requirements for local anesthetic and intraoperative narcotics, longer time until rescue analgesic, and lower incidence of vomiting in the ultrasound-guided group than in the landmark-guided group. Conclusions: The ultrasound-guided DPNB technique appears to offer advantages over classic DPNB and warrants a prospective controlled trial to confirm these findings.