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B45 Ultrasound-guided dorsal penile nerve block gone wrong – how can we reduce the risks?
  1. MB Maio and
  2. H Trindade
  1. Hospital da Luz Lisboa, Lisboa, Portugal


Background and Aims The dorsal penile nerve block (DPNB) is an effective regional anesthesia technique for common procedures including circumcision, urethral surgery and urgent penile interventions. The in-plane ultrasound-guided approach reduces adverse events and improves its efficacy. Nevertheless, space conflict between probe, needle and tissues, along with the risk of local hematoma formation, remain a source of concern.

Methods Consent was obtained from patient’s legal representative.

Results We hereby describe the case of a healthy 4-year-old male patient scheduled for distal hypospadias repair under general anesthesia and DPNB. An ultrasound-guided in-plane approach was used, with the probe transversely positioned at the base of the dorsal aspect of the penis. The needle was advanced piercing Buck’s fascia and 3,5 mL of 0.25% levobupivacaine were administered, initially dissecting the fascia, which was rapidly corrected by needle adjustment. The surgery was uneventful despite the swelling of the dissected tissues, with same-day discharge. The 5th day postoperative consultation revealed a hematoma of the penis and scrotum.

Conclusions The DPNB is a useful resource in elective and emergency settings. The ultrasound-guided approach is now considered the mainstay of regional anesthesia delivery despite not being free of complications. Is it possible to further reduce the risks? The authors suggest the in-plane approach with the probe transversely positioned at the base of the ventral - rather than dorsal - aspect of the penis; its routine use would allow more space for needle adjustments and better visualization of structures, thus reducing the risks associated with the DPNB in the pediatric population.

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