Slow injection of local anaesthetic will decrease pain during dorsal penile nerve block.
OBJECTIVE
To evaluate whether a very slow injection of local anaesthetics during dorsal penile nerve block for circumcision causes less pain than a more rapid injection.


METHODS
In a prospective, double-blind, randomized study, 75 patients aged 15 to 53 yr (mean +/- SD = 22 +/- 8.4 yr) were randomized into two groups. A solution of 2% lidocaine, 1 mg.kg-1, and 0.5% bupivacaine, 0.5 mg.kg-1 without epinephrine to a maximum dose of 10 ml was injected using either a very slow rate (injection time 100 to 150 s, Group A) or a faster rate (injection time 40 to 80 s, Group B). Patients were questioned regarding pain by a physician who was blinded to the mode of therapy. Pain was rated as 1) mild (negligible), 2) moderate (non-negligible, but easily endurable), 3) intense (but endurable) and 4) total refusal to continue.


RESULTS
A significant pain score difference was found between Groups A and B (median = 1 vs. 2, P = 0.0006) as well as a significant correlation between pain score and the rate of infiltration (rs = -0.394, P < 0.0001).


CONCLUSIONS
Slow injection is an important factor in reducing pain during penile block.
Division of Pediatric Surgery, Edith Wolfson Medical Center, Holon, Israel.
F
F
Serour
A
A
Mandelberg
J
J
Mori
D000293:Adolescent; D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects*; D010146:Pain / Q000517:prevention & control*; D010147:Pain Measurement / Q000187:drug effects; D010413:Penis / Q000294:innervation*; D011446:Prospective Studies
D000779:Anesthetics, Local