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Penile blocks provide good analgesia for reducing paraphymosis, following circumcision or dorsal slit.
Anatomy
Source: teachmeanatomy
Dorsal nerve of the penis arises in pudendal canal and passes along ischial ramus. It runs anteriorly along the inferior pubic ramus to pierce the suspensory ligament and enter the subpubic space. The subpubic space is enclosed anteriorly by Buck's fascia (also contains dorsal arteries and deep dorsal vein of the penis). It enters Buck's fascia (fibrous tissue investing the corpus cavernosum) and supplies the skin and glans penis.
The base of penis receives innervation from cutaneous branches of genital branch of genitofemoral nerve.
Complications
Bleeding/haematoma at injection site, intravascular injection, ischaemia/gangrene of penis due to poor technique or use of vasoconstrictors/adrenaline
Technique
Source: Grepmed
- Position patient supine
- Identify the pubic symphysis and insert needle in the midline perpendicular to skin, then angle 20deg laterally to avoid blood vessels
- Advance needle under the pubis until Buck's fascia is traversed ('pop') and subpubic space entered
Tip: Beware of only passing through superficial fascia
- After careful aspiration, inject 50ml of LA
Tip: No resistance should be felt on injection; forced injection of large volumes of LA within Buck's fascia may compromise arterial blood supply and cause penile gangrene
- Withdraw needle into subcutaneous tissue and redirect to the other site to administer 5-10ml of LA
References
Warman P, Conn D, Nicholls B, Wilkinson D. Regional Anaesthesia, Stimulation, and Ultrasound Techniques. Oxford Specialist Handbooks in Anaesthesia.
Author:
Ms Yanyu Tan
| Speciality:
Anaesthetics/ICU
| Date Added:
09/11/2018
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