II. Technique: Dorsal Penile Nerve Block (infants)
- Indications
- Preparation
- Using a 1 cc tuberculin syringe, draw up 1 cc of Lidocaine 1% without Epinephrine
- Attach a 30 gauge 1" needle to syringe
- Procedure
- Patient lies supine
- Assistant holds legs to sides
- Apply antiseptic to injection site (Hibiclens or Betadine)
- Insert needle at dorsal base of penis at 10:00 position
- Insert superficially and raise a small skin wheel
- Advance needle, directed toward midline to a depth of 5mm
- Aspirate to confirm not in vessel
- Deposit 0.4 ml of Lidocaine
- Withdraw needle
- Reinsert needle at 2:00 position and repeat techinque that was performed at the 10:00 position
III. Technique: Topical EMLA (adults)
- Indications
- Pre-Anesthetic prior to local infiltration or Dorsal Penile Nerve Block
- Superficial procedure (e.g. Cryotherapy)
- Penile procedure in a patient with underlying Neuropathy (EMLA alon may be sufficient Anesthesia)
- Apply EMLA to penile skin, local injection site or area of DPNB injection
- Cover penis with Condom
- Onset of action: 45 minutes
IV. Technique: Local Anesthetic infiltration
- Indications
- Preparation
- Consider EMLA Topical Anesthetic first (see above)
- Using a 5cc syringe, draw up 3-5 cc of Lidocaine 1% without Epinephrine
- Attach a 30 gauge 1" needle to syringe
- Procedure
- Patient lies supine
- Apply antiseptic to injection site (Hibiclens or Betadine)
- Insert needle at either side of Laceration or injury site (repeat for opposite side)
- Raise a superficial wheel
- Aspirate and infiltrate Lidocaine subcutaneously
V. Technique: Dorsal Penile Nerve Block - Penile Base (Adults)
- Indications
- Emergency Department Procedures affecting the penis (e.g. Laceration Repair, Paraphimosis reduction)
- Preparation
- Lidocaine 1% 2 ml in 5-10 cc syringe with 27 gauge, 1.25" needle (or 30 gauge, 1" needle)
- Technique
- Patient lies supine
- Mark injection entry sites at 2:00 and 10:00 positions at base of penis
- Apply antiseptic to injection site (Hibiclens or Betadine)
- Technique
- Raise a topical wheal at the 10:00 and 2:00 positions at the dorsal base of the penis
- Advance the needle through the center of each wheal 0.5 cm or until there is no resistance to injection
- Aspirate first, and then slowly inject 0.2 to 0.4 ml of 1% Lidocaine at each of the two sites over 2 minutes
- References
- Warrington (2023) Crit Dec Emerg Med 37(4): 22
VI. Technique: Dorsal Penile Nerve Block - Symphysis Pubis Approach (Adults)
- Indications
- Extensive penile procedure
- Preparation
- Draw all 3 agents into 30 cc syringe and then apply 27 gauge, 1.25" needle
- Typical infiltrate 10-15 cc of mixed solution (less than half of that prepared)
- Anesthetic mix
- Bupivicaine 1% without Epinephrine 10 cc
- Lidocaine 1% with Epinephrine 10 cc
- Normal Saline 10 cc
- Draw all 3 agents into 30 cc syringe and then apply 27 gauge, 1.25" needle
- Procedure
- Patient lies supine
- Mark injection entry site at mid-pubic arch at base of penis
- Apply antiseptic to injection site (Hibiclens or Betadine)
- Technique
- Insert needle, aspirate and inject at both sides of Symphysis Pubis
- Insert at mid-pubic arch perpendicular to skin until needle strikes Symphysis Pubis
- Withdraw a short distance and redirect needle laterally
- Angle to one side of the Symphysis Pubis
- Insert 3-5 mm deep to Symphysis Pubis
- Aspirate to confirm not in vessel and inject 5-7 cc of solution
- Withdraw needle without removing completely from skin
- Repeat injection, redirecting needle to the opposite side of the Symphysis Pubis
- Reference