How is a dorsal penile nerve block administered?

Updated: May 21, 2018
  • Author: Gil Z Shlamovitz, MD, FACEP; Chief Editor: Meda Raghavendra (Raghu), MD  more...
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Answer

Answer

See the list below:

  • The right and left dorsal penile nerves should be blocked as proximally to the base of the penis as possible.

  • Use a 27-ga needle to raise skin wheals at the 2- and 10-o'clock positions (see image below).

    Insertion sites at the 10- and 2-o'clock positions Insertion sites at the 10- and 2-o'clock positions.
  • Slowly insert the needle through the center of each skin wheal.

  • The needle should be directed toward the center of the shaft, to a depth of about 0.5 cm or until loss of resistance is felt to suggest that the tip of the needle is within the Buck fascia.

  • Aspirate to ensure that the needle is not in a blood vessel, and slowly inject about 2 mL of local anesthetic on each side. In neonates and children (< 10 kg), inject 0.2-0.4 mL of lidocaine 1% on each side (10 and 2 o'clock) using a 30-g needle. No more than 4.5 mg/kg should be injected. [7]

  • An alternative method is to inject 2 mL of local anesthetic on either side of the midline, avoiding injecting into the superficial dorsal penile vein (see image below).

    Penile block - Paramidline technique. Penile block - Paramidline technique.

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