Spermatic Cord Block

Aka: Spermatic Cord Block, Regional Anesthesia of the Testicle

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II. Indications

  1. Testicular Torsion
  2. Testicular Trauma

III. Contraindications

  1. Local infection
  2. Coagulopathy
  3. Distorted or abnormal regional anatomy

IV. Complications

  1. Local bleeding
  2. Infection
  3. Misplaced needle and Anesthetic
  4. Failed Anesthesia
    1. Spermatic Cord Block does not anesthetize the scrotal skin

V. Preparation

  1. Syringe 10-20 ml
  2. Appropriate needle for depth (e.g. 27 gauge 1.25 inch)
  3. Skin antiseptic (e.g. Chlorhexidine)
  4. Anesthetic (5-15 ml)
    1. Ropivacaine
    2. Bupivacaine
  5. Ultrasound Guidance (preferred)
    1. High frequency linear probe
    2. Sterile Ultrasound probe cover

VI. Technique

  1. Obtain procedure consent
  2. Landmarks
    1. Anterior superior iliac spine (ASIS)
    2. Pubic tubercle
      1. Injection site is 1 cm medial and inferior to the pubic tubercle
  3. Clean, drape and prepare the site
    1. Apply antiseptic (e.g. Chlorhexidine)
  4. Insert needle directed toward landmark (ideally with Ultrasound guidance)
    1. Avoid injecting directly into nerve
    2. Surround the nerve under Ultrasound guidance with 5-15 ml Anesthetic

VII. References

  1. Warrington (2025) Crit Dec Emerg Med 39(9): 19

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