Circumcision, Meatotomy or Distal Coronary Correction of Hypospadia Clinical Trial
Official title:
Comparison of Dorsal Penile Nerve Block (DPNB According to Dalens' Technique) to Dorsale Penile Nerve Block With Ventromedial Infiltration
Dorsal penile nerve block (DPNB) is a regional nerve block probably most often performed throughout the world. There are several different methods described in the literature. When compared to penile ring wall infiltration or caudal block, the Dorsal penile nerve block (DPNB) is more likely associated with the risk of failure of the block quality. The aim of this study is to compare the quality of the standard method of Dorsal penile nerve block (DPNB)(Dalens' technique) with that of a modified procedure (Dorsal penile nerve block (DPNB)with additional infiltration of the ventromedial penis at the transition between the penis and the scrotum.
Male circumcision is the most often performed operation in male children throughout the
world. In the western world it is not accepted to perform this procedure without adequate
analgesic support. Hence the dorsal penile nerve block (DPNB), first described in the 70ies
of the 20th century, is one of the most frequently performed regional anesthetic procedures
in both children and adults. There are several methods described in the literature, of which
the one described by Dalens et al in 1989 nowadays is the most often quoted and most
frequently performed method. The reported rate of insufficient analgesia by DPNB is higher
than caudal block or penile ring wall infiltration. It is known from neuroanatomic studies,
that the penis is innervated mostly, but not only by the dorsal penile nerve, a final branch
of the pudendal nerve. A varying amount of the ventral penile skin, especially of the
preputium and the frenulum, is innervated by fine end branches of the perineal nerve, which
otherwise gives sensoric innervation to the scrotum and motor innervation to the
bulbospongiosus muscle. An injection of local anesthetic underneath Buck's fascia is unable
to reach the perineal nerve, which may be the explanation for these failures.
In this study we compare two different techniques of performing the dorsal penile nerve block
(DPNB): the technique according to Dalens, and a modification, where a small amount of the
local anesthetic for the dorsal penile nerve block (DPNB) is withheld, and then injected
subcutaneously at the ventral transition between the penis and the scrotum in the midline.
The latter injection at the site of perineal innervation is a relic of the penile ring wall
infiltration, which surely blocks all skin fibres of both the dorsal penile nerve and the
perineal nerve.
All patients included randomly receive either two injections at the dorsum penis according to
Dalens' technique, or two injections at the dorsum penis according to Dalens' technique plus
on subcutaneous injection in the ventral midline of the penis at the transition between the
penis and the scrotum. The amount of local anesthetic (bupivacaine 0,75%, 0,2 ml/kg of body
weight) and dosing of narcotics (Sevoflurane 2,2 Vol% end-expiratory gas in an oxygen-air
mixture) is the same in both groups.
;