Background

A dorsal penile nerve block is an anesthetic technique used for procedures involving the penis.  

The procedure like circumcisions, repair of penile injuries, or minor surgical interventions.  It numbs penis nerve with anesthetic injection for sensory relief and nerve protection. 

Pudendal nerve branches and dorsal nerves are supplying penis to provide sensation for most of sensitive skin on dorsal side. 

The final branches of the pudendal nerve from the sacral plexus innervate various perineal structures and genitals. 

Nerve splits into right and left dorsal nerves to provide sensory innervation to the penis. 

The penile shaft consists of corpora cavernosa, corpus spongiosum, fascial layers, nerves, lymphatics, blood vessels, and skin. 

Two elastic suspensory ligaments support the penis base. Parenteral analgesia with sedation is recommended before local penile anesthesia. 

It gives satisfactory pain relief during and after the procedure. The systemic effects of the anesthetic are minimal compared to general anesthesia. 

The block is relatively simple to perform thus it does not require any advanced equipment. 

Indications

Circumcision: 

The dorsal penile nerve block is used for pain management in circumcisions in neonates and children. 

Minor Penile Surgeries: 

In minor surgeries with the foreskin, glans, or shaft of the penis. 

Frenuloplasty: 

Surgical correction of the penile frenulum can be performed under a dorsal penile nerve block. 

Painful Penile Conditions 

Priapism 

Postoperative Pain 

Contraindications

Absolute Contraindications are: 

• Allergy to Local Anesthetics 
• Infection at the Injection Site 
• Severe Coagulopathy 

Relative Contraindications are: 

• Localized Vascular Malformations 
• Mild to Moderate Coagulopathy 
• Preexisting Neurological Disorders 

Outcomes

Effective pain management during procedures such as circumcision, penile biopsies, or minor surgeries results in minimal pain for patients when a successful nerve block is administered. 

It provides long-lasting pain relief post-procedure to decrease need for additional analgesics and improve comfort. 

Dorsal penile nerve block enables minor procedures to be done under local anaesthesia in pediatric or adult patients. Minimal absorption of anesthetic lowers risk of toxicity and side effects. 

Parents prefer pediatric blocks for children’s comfort, while adults benefit from effective pain management with blocks. 

It decreased need for pain post-surgery improves patient satisfaction to minimize side effects. 

Equipment required

Sterile Gloves and Drapes 

Local anesthetic solution 

Syringe 

Needles 

Patient Preparation

All necessary equipment is available in good condition including local anesthetics, syringes, and needles. 

Assess the anatomical landmarks to check for any infections at the injection site and evaluate the penis region. 

Patients should follow as instructed by the physician. Fast for few hours before the procedure to reduce the risk of aspiration. 

The procedure is performed in a sterile environment. Always use sterile gloves, drapes, and instruments. 

Clean the injection site with an antiseptic solution to minimize the risk of infection.  

Informed Consent:  

Patients should understand procedure, benefits, risks, and alternatives for consent. 

Patient Positioning

The patient is positioned supine for easy access to the base of the penis. 

Fig. Dorsal penile nerve 

Technique

Step 1: Identification of Anatomical Landmarks: 

The penile shaft is palpated to identify the base of the penis. 

The dorsal nerve run at the 10 and 2 o’clock positions near the base of the penis, lateral to the midline and superficial to the deep dorsal vein. 

Step 2: Preparation for anesthesia: 

Collect a local anesthetic into a syringe. The total volume ranges from 1 to 3 ml. 

A fine needle with gauge and 1 to 1.5 inches long is attached to the syringe to minimize discomfort during injection. 

Step 3: Administration of the Block: 

The skin at the base of the penis is gently pulled taut to stabilize the tissue. 

Step 4: Needle Insertion:  

The needle is inserted at the 10 o’clock position first, i.e. perpendicular to the skin and advanced until it reaches the fascia surrounding the dorsal nerves. 

The healthcare provider should aspirate and ensure the needle is not in a blood vessel. 

Step 5: Injection:  

Slowly inject the local anesthetic 1-3 ml into the tissue surrounding the dorsal nerve. Withdraw the needle slightly and redirect it as needed. 

The procedure is repeated at the 2 o’clock position on the opposite side of the penis. 

Step 6: Verification of Block: 

Wait for a few minutes. The block should be effective within 5-10 minutes. 

Gently pinch the skin of the penis to check for loss of sensation, that indicates a successful block. 

Complications

Hematoma: 

If a blood vessel is inadvertently punctured during the injection. 

Incomplete or Failed Block: 

The block may be incomplete or fail if the anesthetic is not adequately distributed. 

Prolonged Numbness or Dysesthesia: 

If the anesthetic affects the nerve for longer than expected or it shows nerve irritation. 

Nerve Injury: 

There is a small risk of nerve injury that causes chronic pain or loss of function in the affected area. 

Infection 

Allergic Reactions 

References

Dorsal Penile Nerve Block – StatPearls – NCBI Bookshelf (nih.gov) 

References

Dorsal Penile Nerve Block – StatPearls – NCBI Bookshelf (nih.gov)