Comparison between circumferential local anesthesia and dorsal penile nerve block in circumcision procedure
Objectives: To compare circumferential local anesthesia and dorsal penile nerve block with regard to pain control during adult circumcision.
Materials and Methods: A randomized, controlled clinical trial was conducted and 30 men were randomly assigned into one of the following groups: circumferential local anesthesia (LA) and dorsal penile nerve block (DNB). Patients in both groups were injected with 0.2 ml/kg of 2% lidocaine without epinephrine before circumcision using the different techniques. During the operation, pain score was evaluated in accordance with the Numerical Rating Scale (NRS) and the data were compared using the Mann-Whitney test.
Results: The patients in the LA group felt more pain than those in the DNB group during anesthetic injection (4.73 vs 3.7, p<0.05) but the pain scores were lower than in the DNB group during the outer prepuce incision (0.47 vs 3.93, p<0.05), inner prepuce incision (0.33 vs 1.47, p<0.05) and incision near/at Frenulum (0.33 vs 4.47, p<0.05). Overall pain score was higher in the dorsal penile nerve block group (1.53 vs 2.6, p <0.05). The circumferential local anesthesia is equally effective through all stages of the circumcision whereas the dorsal penile nerve block was not effective at the ventral surface of penis.
Conclusion: For pain control in circumcision, circumferential local anesthesia is more effective than dorsal penile nerve block.
Weiss HA, Thomas SL, Munabi SK, Hayes RJ. Male circumcision and risk of syphilis, chancroid, and genital herpes: a systematic review and meta-analysis. Sex Transm Infect 2006;82:101-9.
Gray RH, Li X, Kigozi G, Serwadda D, Nalugoda F, Watya S, et al. The impact of male circumcision on HIV incidence and cost per infection prevented: a stochastic simulation model from Rakai, Uganda AIDS 2007;21:845-50.
Larke NL, Thomas SL, Silva IdS, Weiss HA. Male circumcision and penile cancer: a systematic review and meta-analysis. Cancer Causes Control 2011;22:1097-110.
Shapiro E. American Academy of Pediatrics policy statements on circumcision and urinary tract infection. Rev Urol 1999;6:154-6.
Ferrandiz C, Ribera M. Zoon’s balanitis treated by circumcision. J Dermatol Surg Oncol 1984;10:622-5.
Kirya C, Werthmann MW. Neonatal circumcision and dorsal penile nerve block - a painless procedure. J Pediatr 1978;92:998-1000.
Brown TC, Weidner NJ. Bouwmeester J. Dorsal Nerve of Penis Block. Anaesth Intensive Care 1989;17:34-8.
Lacy CF, Amstrong LL, Goldman MP, Lance LL, editors. Drug information handbook with international trade names index. 19th ed. Ohio: Lexi-Comp; 2016. p. 2010-11.
Holve RL, Bromberger PJ, Groveman HD, Klauber MR, Dixon SD, Snyder JM. Regional anesthesia during newborn circumcision. Clin Pediatr (Phila) 1983;22:813-8.
McCammon KA, Zuckeman JM. Surgery of The Penis and Urethra. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, editors. Campbell-Walsh Urology. 11th ed. Philadelphia: Elsevier; 2016. p. 915.
Kim TK. Practical statistics in pain research. Korean J Pain. 2017;30:243-9.
Jin XD, Lu JJ, Liu WH, Zhou J, Yu RK, Yu B, et al. Adult male circumcision with a circular stapler versus conventional circumcision. Braz J Med Biol Res 2015;48:577-82.
Ucho EM, Yang CC, Kromm BG, Bradley WE. Cortical evoked responses from the perineal nerve. J Urol 1999;162:542-63.
Sara CA, Lowry CJ. A complication of circumcision and dorsal nerve block of the penis. Anaesth Intensive Care 1985;13:79-85.
Copyright (c) 2021 Insight Urology
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.