Penile block is a block of the dorsal nerve of the penis. Indications are circumcision and simple hypospadias repair (if no caudal).

Procedure:

• Sterile precautions
• Pull skin taut
• Infra pubic injection
• Midline needle, perpendicular insertion gently advance posteriorly
• 2 'pops': superficial fascia: slight; deep fascia: definite pop
• May not always feel a pop as the fascia is penetrated because it is very thin in small children.
• Aspirate and inject 0.1 ml/kg 0.25% bupivacaine (small volume is used to avoid filing the space and causing vascular compromise)

Alternatively, the needle may be directed to each one of the sides of the shaft of the penis to inject local anaesthetic.

Important points to note:

• Performed when the child is asleep, after induction of anaesthesia
• Do not add adrenaline to the local anaesthetic solution!
• Supplement with simple analgesics and topical local anaesthetic gel post-op

Further reading: e-SAFE/e-library - 09 Anaesthesia: Regional/Penile Block