A preliminary study of the sensory distribution of the penile dorsal and ventral nerves: implications for effective penile block for circumcision.

Hdl Handle:
http://hdl.handle.net/10147/206326
Title:
A preliminary study of the sensory distribution of the penile dorsal and ventral nerves: implications for effective penile block for circumcision.
Authors:
Long, Ronan M; McCartan, Damian; Cullen, Ivor; Harmon, Dominic; Flood, Hugh D
Affiliation:
Department of Urology, Mid-Western Regional Hospital, Dooradoyle, Limerick,, Ireland. ronanlong@hotmail.com
Citation:
BJU Int. 2010 Jun;105(11):1576-8. Epub 2009 Nov 4.
Journal:
BJU international
Issue Date:
31-Jan-2012
URI:
http://hdl.handle.net/10147/206326
DOI:
10.1111/j.1464-410X.2009.09044.x
PubMed ID:
19889061
Abstract:
OBJECTIVE: To determine the sensory innervation of the penis, as regional anaesthesia is often used either for postoperative analgesia or as the sole anaesthetic technique for circumcision. Since first described in 1978 the dorsal penile nerve block has become the standard technique, but some blocks are ineffective; a better understanding of the sensory innervation of the penis might improve the efficacy of the dorsal penile block technique. PATIENTS AND METHODS: In 13 men undergoing circumcision with local anaesthetic, cutaneous sensation was tested before and after infiltration of the dorsal aspect of the penis, and then again after infiltration of the ventral aspect. The area of anaesthesia was mapped using pin-prick sensation. RESULTS: Ten of the 13 patients showed a similar pattern of sensory distribution. After the dorsal block, the dorsal aspect of the shaft of the penis and glans penis became insensate. The ventral aspect of the shaft remained sensate up to and including the frenulum. After successful ventral infiltration all sensate areas became insensate and circumcision proceeded. In one case the frenulum and distal ventral foreskin was anaesthetized after the dorsal block and ventral infiltration was not required. No patient experienced pain during circumcision. CONCLUSION: For consistently successful regional anaesthesia of the foreskin in circumcision, a dorsal block must be used. This should be combined with ventral infiltration at the site of incision. This method will avoid inconsistencies and allow pain-free circumcision using local anaesthesia in most men.
Language:
eng
MeSH:
Adolescent; Adult; Aged; Anesthesia, Local; *Circumcision, Male; Humans; Male; Middle Aged; Nerve Block/*methods; Pain/prevention & control; Penis/*innervation/surgery; *Sensory Receptor Cells; Young Adult
ISSN:
1464-410X (Electronic); 1464-4096 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorLong, Ronan Men_GB
dc.contributor.authorMcCartan, Damianen_GB
dc.contributor.authorCullen, Ivoren_GB
dc.contributor.authorHarmon, Dominicen_GB
dc.contributor.authorFlood, Hugh Den_GB
dc.date.accessioned2012-01-31T16:48:11Z-
dc.date.available2012-01-31T16:48:11Z-
dc.date.issued2012-01-31T16:48:11Z-
dc.identifier.citationBJU Int. 2010 Jun;105(11):1576-8. Epub 2009 Nov 4.en_GB
dc.identifier.issn1464-410X (Electronic)en_GB
dc.identifier.issn1464-4096 (Linking)en_GB
dc.identifier.pmid19889061en_GB
dc.identifier.doi10.1111/j.1464-410X.2009.09044.xen_GB
dc.identifier.urihttp://hdl.handle.net/10147/206326-
dc.description.abstractOBJECTIVE: To determine the sensory innervation of the penis, as regional anaesthesia is often used either for postoperative analgesia or as the sole anaesthetic technique for circumcision. Since first described in 1978 the dorsal penile nerve block has become the standard technique, but some blocks are ineffective; a better understanding of the sensory innervation of the penis might improve the efficacy of the dorsal penile block technique. PATIENTS AND METHODS: In 13 men undergoing circumcision with local anaesthetic, cutaneous sensation was tested before and after infiltration of the dorsal aspect of the penis, and then again after infiltration of the ventral aspect. The area of anaesthesia was mapped using pin-prick sensation. RESULTS: Ten of the 13 patients showed a similar pattern of sensory distribution. After the dorsal block, the dorsal aspect of the shaft of the penis and glans penis became insensate. The ventral aspect of the shaft remained sensate up to and including the frenulum. After successful ventral infiltration all sensate areas became insensate and circumcision proceeded. In one case the frenulum and distal ventral foreskin was anaesthetized after the dorsal block and ventral infiltration was not required. No patient experienced pain during circumcision. CONCLUSION: For consistently successful regional anaesthesia of the foreskin in circumcision, a dorsal block must be used. This should be combined with ventral infiltration at the site of incision. This method will avoid inconsistencies and allow pain-free circumcision using local anaesthesia in most men.en_GB
dc.language.isoengen_GB
dc.subject.meshAdolescenten_GB
dc.subject.meshAdulten_GB
dc.subject.meshAgeden_GB
dc.subject.meshAnesthesia, Localen_GB
dc.subject.mesh*Circumcision, Maleen_GB
dc.subject.meshHumansen_GB
dc.subject.meshMaleen_GB
dc.subject.meshMiddle Ageden_GB
dc.subject.meshNerve Block/*methodsen_GB
dc.subject.meshPain/prevention & controlen_GB
dc.subject.meshPenis/*innervation/surgeryen_GB
dc.subject.mesh*Sensory Receptor Cellsen_GB
dc.subject.meshYoung Adulten_GB
dc.titleA preliminary study of the sensory distribution of the penile dorsal and ventral nerves: implications for effective penile block for circumcision.en_GB
dc.contributor.departmentDepartment of Urology, Mid-Western Regional Hospital, Dooradoyle, Limerick,, Ireland. ronanlong@hotmail.comen_GB
dc.identifier.journalBJU internationalen_GB
dc.description.provinceMunster-

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