Techniques in Local Anaesthesia for Penile procedures and surgery

1. Local Anaesthesia for
Penile Procedures
Dr. F. Brakatu

2. Common Penile Procedures under LA
Urethral catheterization - Intra-urethral local instillation
Circumcision - Penile block + Local Infiltration
Meatotomy - Spongiosal block + Local Infiltration
Dorsal Slit - Penile block + Local Infiltration
Prosthesis Insertion - Crural block + Local Infiltration
Penile Vascular Procedures - Penile block + Local Infiltration

3. Relevant Anatomy

4. Intra-urethral local anaesthetic instillation
Blocks the urethral submucosal plexus
of nerves
For catheterizations and urethroscopies

5. Dorsal Penile Nerve Block

6. Subcutaneous Penile Ring Block

7. DPNB via a Perineal Approach
CB (n=52) vs DPNB (n=52)
No significant difference in
HR & RR
Similar pain scores
Shorter time for 1st
micturition after DPNB than
CB

8. Intracorpus Spongiosal Block

9. Transillumination-guided Urethral Block
For short segment anterior urethral strictures
Blocks cavernosal nerves at proximal (3 & 9 o’clock ) and
distal urethra (12 o’clock)
Feasible for morbid patients unfit for SA or GA who need
DVIU
Simple & Cost-effective
Author has performed 55 DVIUs with this technique
successfully
No conversion to another anaesthesia & no sedation
required
Needs further comparative studies

10. Take Home Message
~ Always Consider LA as an option
~ Always calculate the toxic dose of LA and stay within safe limits
~ LA can complement other methods to decrease analgesic requirement
~ Prepare to complement with IV Sedation if necessary
~ LA may be an option in morbid patients unfit for surgery