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Penile nerve block

If you have a private operation planned, it may involve an anaesthetic procedure, in this instance a penile nerve block. You may wish to know what this involves.
 
The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things, so you should follow their guidance where it is different from the information given here. Because all patients, conditions and treatments vary it cannot cover everything. Use this information when making your treatment choices with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.

 

 

What is the problem?

You have a condition that requires an operation on your penis, such as a circumcision.

 

What is a penile nerve block?

A penile nerve block is an injection of local anaesthetic into the lower tummy (abdomen), which numbs the nerves that go to the penis. This is one of many types of nerve block. This particular nerve block is almost always used with a general anaesthetic for an operation on the penis. Therefore, you will be asleep when the penile nerve block is done.

Penile nerve block
Penile nerve block 2

 

The block will numb the penis for the operation and will last for several hours afterwards. One advantage of the block is that it reduces the amount of other strong painkillers, such as morphine, needed during and after the operation.

 

The aims

The aim is to numb your penis so that you feel no pain during the operation. The block will provide pain relief during the operation and for several hours afterwards. Your anaesthetist will talk to you before doing the block and explain what happens.

 

The benefits

There are a number of benefits. You may have other serious medical conditions, such as heart or lung disease. In this case a general anaesthetic alone may have slightly more risk than normal. Doing the block, with a general anaesthetic will cause less stress to your medical condition and be safer.

 

The block gives excellent pain relief both during and after surgery. This means that the anaesthetist does not need to give you as much anaesthetic or strong painkillers. This means a faster recovery and less sickness after the operation.

 

Are there any alternatives?

There are several alternatives to a penile nerve block. These are:

 

General anaesthetic - You can have your general anaesthetic, where you are completely asleep throughout, but without the penile nerve block. Other strong painkillers like morphine can be given to keep you comfortable when you wake up. The penile block would give good pain relief after the operation. It would avoid the need for repeated injections of painkillers once you are awake.

 

Epidural - It may be possible to perform an epidural where the lower part of the body goes numb and is pain free. This involves placing a plastic tube next to the nerves in the spine, so that drugs can be injected, making the nerves stop working temporarily. The epidural could be used without a general anaesthetic. You would be awake for the operation.

 

Spinal - Alternatively a single injection, like an epidural, but without putting the plastic tube in, can be used. This single injection is called a spinal. It does not last as long as an epidural. The spinal injection could be used without a general anaesthetic. You would be awake for the operation.

 

Local anaesthetic - Sometimes, if the surgery is minor, local anaesthetic injections can be used to numb the operation area only.

 

If you are to have one of these procedures there is another information leaflet that will tell you more about it.

 

Who should have it done?

The penile block is used for patients needing surgery on the penis.

 

Who should not have it done?

You have the final decision to proceed or not. If you are unhappy about the procedure for any reason, you should not continue. There are specific medical situations when a penile nerve block should not be done and they are as follows:

 

  • Medication that prevents your blood from clotting, such as Warfarin; this would lead to more bleeding than normal. Bleeding around the nerves in the penis is a serious problem and must be avoided.

  • An illness that prevents your blood from clotting, such as haemophilia; this would lead to more bleeding around the nerves in the penis.

  • Infection of the skin over the site where the needle needs to be put in; this could lead to further infection in the deeper tissues and possibly blood poisoning. This could also cause infection around the nerves.

  • Unusual or difficult anatomy; this would make it difficult to put the needle in the correct place.

  • Previous injury or disease affecting the lower tummy. Perhaps you have had a previous injury to your lower abdomen or pelvis.

 

Author: Dr Sean White FRCA. Consultant in pain and anaesthesia

© Dumas Ltd 2006

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