What types of anesthesia are used to perform a no-scalpel vasectomy (NSV)?

Updated: Jan 19, 2016
  • Author: M David Stockton, MD, MPH; Chief Editor: Edward David Kim, MD, FACS  more...
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See the list below:

  • Lidocaine 1% with or without epinephrine can be used to anesthetize the scrotal skin puncture site.

  • Use a tuberculin syringe with a 0.375-inch fine point needle to raise a blanched skin wheal. For more information, see Local Anesthetic Agents, Infiltrative Administration.

    Raising the skin wheal. Raising the skin wheal.
    Side view of the skin wheal. Side view of the skin wheal.
  • A bilateral perivasal block is accomplished by injecting lidocaine 1% or bupivacaine 0.25% or 0.5% by tracking a 27-gauge 1.5-inch needle along the path of the vas toward the inguinal ring as shown.

    Advancing the needle parallel to the vas within th Advancing the needle parallel to the vas within the external spermatic fascial sheath toward the inguinal ring.
  • Optionally, many practitioners have the patient take an oral sedative, such as 1-2 mg lorazepam, 30 minutes prior to the procedure. In this case, the practitioner must be assured the patient has arranged for someone to drive him home after the procedure. If the oral sedative is to be administered before the patient comes to the office, someone must drive him to the office, as well.

  • Alternatively, a no-needle anesthetic technique is increasing in popularity compared with the standard needle infiltrative technique and uses a jet-injector device to deliver a high-pressure anesthetic spray of 0.3 mL lidocaine 2% through the intact skin and into the vas and surrounding vas tissues (Medajet Medical Injector; MADA Medical Products; Carlstadt, NJ). [6]

  • Attempts to use a topical skin anesthetic agent (ie, EMLA) prior to local injection of lidocaine failed to offer any benefit in perceived pain as shown by a visual analog scale. [7]

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