Dorsal penile nerve block via injection into the subpubic space using a short-axis in-plane approach: A technical description

The dorsal penile nerve supplies sensation to the dorsal surfaces of the penis and glans. The dorsal penile nerve block provides sensory blockade of the nerves supplying this region, rendering it an effective technique for pediatric circumcision and distal hypospadias repair. We describe the methodology of an ultrasound-guided dorsal penile nerve block via injection into the subpubic space using a short-axis, in-plane approach. This technique involves ultrasound visualization of the bilateral subpubic spaces in a single axial (short-axis) view slightly cephalad to the penile base. Using an in-plane approach from the lateral aspect, the needle is advanced beneath Scarpa's fascia into the subpubic space, and 0.1 mL/kg of 0.25% ropivacaine is injected on each side. Correct placement is confirmed by the spread of local anesthetic within both compartments. The advantages of this technique are based on anatomical and technical considerations, including continuous in-plane needle visualization and improved identification of bilateral subpubic spaces without the need for probe translation. While careful attention is required to avoid injury to the corpus cavernosum or spermatic cord, this short-axis, in-plane technique represents a feasible alternative approach for ultrasound-guided dorsal penile nerve block.