Anaesthesia for Circumcision
I use a 2ml amp of 1% lignocaine plain. Ensuring there is NO ADRENALINE. The recommended upper dose is 0.3mg per Kg eg 1.5ml of 1% lignocaine for a 5kg infant.
I do an injection at 10 and 2 o'clock with a bleb, going through buck's fascia - the deep fascia, as the dorsal nerve is under that structure, being careful to avoid the vessels.
With the common situation of rotation in the penis, the dorsal vein should be regarded as 12 o’clock, to avoid the dorsal arteries which lie either side of the vein. Some is injected superficial and some is just deep to the fascia. I also do a ventral ring at the scrotal/penile border to pick up the innervation from the superficial perineal nerve. I do an injection on each side at the skin crease where penis and pubis meet - going perpendicular to the skin and in about 1 cm. Resistance to injection lessens when you are in the sub-pubic space through which the dorsal nerve passes - see diagram. Total dose given about 1.5 ml of 1% lignocaine plain for a baby of 4-5 Kg
This may seem a lot of areas, but I have discovered that if I do this, I will almost always have total anaesthesia of the penis, and a relaxed baby. They are also given paracetamol, morphine liquid (0.05mg per Kg to a maximum of 0.25mg), and Lignocaine cream to the injection area 60 mins before surgery. PS. dont bother withdrawing to check for vessels - if you hit a vessel the syringe flashes back blood. If that happens, just reposition the needle and keep going. After injecting local, get your nurse to pinch the penis gently at the site of the flashback to reduce bruising.
Wait 5 minutes for effective anaesthesia.