Page 1 of 1 The Anatomy and Technique of Penile Block T.C.K. Brown, Royal Children's Hospital, Melbourne, Australia. Anatomy Method Anatomy Penile block has been widely used for circumcision. Complications include inadequate block or, rarely, ischaemia.
Techniques vary from injection below the symphysis pubis to ring block of the shaft.
The anatomy related to penile block is one of the least understood areas by anaesthetists. The fact that the fascia splits on its deep surface to form a vertical suspensory ligament of the penis which, in turn, divides to encircle the shaft of the penis. The dorsal nerves and vessels lie deep to the suspensory ligament where it divides on the corpora cavernosa and are therefore in an enclosed space where they could be depressed if a large haematoma developed. The safest technique is to inject an adequate volume of local anaesthetic bilaterally deep to the fascia into the pear shaped spaces on each side of the suspensory ligament. This avoids mid- line injection and therefore potential damage to the dorsal vessels and provides the maximum chance of diffusion into the nerves to block them.