An unusual complication of dorsal penile nerve block for circumcision

Abacı, Ayhan; Makay, Balahan; Ünsal, Erbil; Olguner, Mustafa; Aktuğ, Tanju

doi:10.1111/j.1460-9592.2006.01941.x

Cited by 14 publications

(4 citation statements)

References 7 publications

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“…Despite the low technical failure rate, it is an easy, safe and effective method [1,4]. However, it may lead to several complications, with rates of 0.2-5% [1,5,6,[13][14][15]. Currently, there is not enough evidence of the etiology and pathophysiology of some of these complications, especially penile ischemia.…”

Section: Discussionmentioning

confidence: 98%

Investigation of the effect of dorsal penile block to penile tissue

Boybeyi

Günal

Atasoy

et al. 2015

Journal of Pediatric Urology

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Section: Discussionmentioning

confidence: 98%

Investigation of the effect of dorsal penile block to penile tissue

Boybeyi

Günal

Atasoy

et al. 2015

Journal of Pediatric Urology

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“…A recent study of the technique estimated the total complication rate for the dorsal penile nerve block to be 0.18% [1]. The complications described include urethral injuries, accidental injection of an incorrect drug, bleeding from the prepuce, ischial osteomyelitis, and ischaemia and necrosis of the glans penis [1,3,4,7,8]. Currently, the literature does not provide a defined aetiology, pathophysiology or management protocol for this ischaemia.…”

Section: Discussionmentioning

confidence: 99%

“…It is a simple, easy and effective block that reduces postoperative pain and analgesic requirements. A number of complications have, however, been reported [1][2][3][4]. Ischaemia of the glans penis is a rare complication associated with this block and may arise via a number of mechanisms [3].…”

mentioning

confidence: 99%

Caudal anaesthesia as a treatment for penile ischaemia following circumcision

Kaplanian¹,

Chambers

Forsyth

2007

Anaesthesia

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SummaryWe report an ischaemic penile glans following circumcision and a dorsal penile nerve block in a 9-year-old boy. Ischaemia of the glans penis is a rare complication associated independently with both circumcision and dorsal penile nerve blocks. There are a number of pathophysiological mechanisms of this ischaemia and its management is varied and not well recorded. We report the successful management of this complication using a caudal epidural block and also discuss technical aspects of penile nerve blocks. Circumcision is a commonly performed surgical procedure with a low complication rate. Penile ischaemia is a rare complication of circumcision and surgical causes include haematoma, vessel ligation, and an excessively tight suture line.The dorsal penile nerve block is a widely used form of regional anaesthesia, particularly in children [1]. It is a simple, easy and effective block that reduces postoperative pain and analgesic requirements. A number of complications have, however, been reported [1][2][3][4]. Ischaemia of the glans penis is a rare complication associated with this block and may arise via a number of mechanisms [3].We report a case of ischaemic glans penis following circumcision and dorsal penile nerve block in a 9-yearold boy which was managed successfully with a caudal block. Case reportA healthy 9-year-old, 38-kg Caucasian boy presented for an elective circumcision. Following intravenous induction of anaesthesia, with the child spontaneously breathing oxygen and isoflurane through a laryngeal mask airway, a dorsal penile nerve block was performed under sterile conditions with a 22-G blunt-bevel needle. The subpubic approach to the dorsal nerves of the penis was used [5], with the child lying in the supine position and the penis pulled inferiorly. Two symmetrical injections 1 cm lateral to the midline, and just below the lower border of the pubis symphysis, were performed. The needle was inserted almost perpendicularly to the skin with slight caudal and medial angulation. After aspiration, to exclude intravenous placement of the needle, 3 ml 0.5% plain bupivacaine was injected on each side. The block appeared uncomplicated. An uneventful classic circumcision was then performed using bipolar diathermy. However, in recovery, the block appeared ineffective and the child required a total of 6 mg morphine to control significant pain. Examination of the penis at this point showed no evidence of bleeding, haematoma or vascular compromise.Four hours later, nursing staff requested urgent surgical and anaesthetic consultations. The boy had ongoing pain and examination revealed a flaccid penis with a significantly ischaemic, poorly perfused, almost black, glans. Significantly, the penile shaft was well perfused and there was no sign of swelling, haematoma or bruising, either at the site of the penile block or at the glans. An urgent duplex Doppler demonstrated good blood flow in both penile arteries distal to the block site. Surgical opinion was that the viability of the glans was threatened but the...

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“…17.4), grey-scale and colour Doppler ultrasonography show thickened vessel wall and complete or segmental thrombosis (Dicuio et al 2005;Abaci et al 2006;Shamloul and Kamel 2006), which can be occasionally associated with thrombosis of the circumfl ex veins. 17.4), grey-scale and colour Doppler ultrasonography show thickened vessel wall and complete or segmental thrombosis (Dicuio et al 2005;Abaci et al 2006;Shamloul and Kamel 2006), which can be occasionally associated with thrombosis of the circumfl ex veins.…”

Section: Ultrasonographic Featuresmentioning

confidence: 99%

Color Doppler US of the Penis

Bertolotto¹

2008

Medical Radiology

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An unusual complication of dorsal penile nerve block for circumcision

Cited by 14 publications

References 7 publications

Investigation of the effect of dorsal penile block to penile tissue

Investigation of the effect of dorsal penile block to penile tissue

Caudal anaesthesia as a treatment for penile ischaemia following circumcision

Color Doppler US of the Penis

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