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The dorsal penile nerve block is an effective technique for gaining regional anesthesia of the penis with small volumes of a local anesthetic. The technique is essential for all practicing urologists and desirable for those who work in emergency departments who see acute presentations such as paraphimosis. This activity describes the indications, contraindications, and potential complications of a dorsal penile nerve block. Objectives: Identify the indications for performing a dorsal penile nerve block. Outline anesthetic agents that should be avoided in performing a dorsal penile nerve block. Describe the potential adverse effects of a dorsal penile block. Review how an interprofessional team approach can provide care for patients requiring a dorsal penile block and improve outcomes. Access free multiple choice questions on this topic.

The dorsal penile nerve block is an effective technique for gaining regional anesthesia of the penis with small volumes of a local anesthetic. The technique is essential for all practicing urologists and desirable for those working in emergency departments that see acute presentations, such as paraphimosis.

The most common complication is a patient complaining of pain during any subsequent procedure. This may represent an incomplete block, the patient experiencing tactile sensation, or insufficient time for the block to take full effect (typically 10 to 15 minutes). Pain during injection can be reduced by slowing the rate of injection of the local anesthetic.[5] Bleeding and hematomas are common and can usually be controlled with pressure and dressings. Local anesthetics with adrenaline/epinephrine should never be used, as this has been associated with tissue damage and ischemia.[6]

An interdisciplinary team comprising the clinician performing the procedure and an experienced nurse assistant yields the best clinical outcomes. During the procedure, the nurse can provide instruments and communicate with the patient to reduce their anxiety.