title: No-needle local anesthesia for adult male circumcision.
abstract: OBJECTIVE
  We used a local anesthetic jet injection technique for adult male circumcision. This method eliminates needle use and may decrease the fear of local anesthetic injection used for male circumcision.
  
  
  METHODS
  We recruited 60 men seeking voluntary adult male circumcision into the study from June to September 2009. We used a MadaJet Medical Injector to deliver a high pressure spray of 0.1 ml 2% plain lidocaine solution directly through the penile skin circumferentially around the proximal third of the penis. All men underwent circumcision using the Shang Ring and were evaluated for anesthetic safety, efficacy and acceptability. Pain was measured on a visual analog scale.
  
  
  RESULTS
  The average volume of 2% lidocaine anesthetic solution delivered by jet injection was 0.1 ml with a mean total of 0.9 ml per circumcision procedure. More than 85% of men did not require supplemental anesthesia. Anesthetic onset required approximately 45 seconds from the time that injections were completed. Mean pain scores for immediate postoperative, 24-hour postoperative, ring removal and post-ring removal events were 0.1, 6.8, 2.2 and 0.9, respectively. In 4 patients (6.67%) mild urethral bleeding resolved with pressure, resulting in technique modification.
  
  
  CONCLUSIONS
  No-needle jet injection is safe and effective for adult MC. The technique efficiently delivers local anesthesia with rapid onset in men undergoing circumcision. This needle-free approach may enhance the popularity of adult male circumcision.
authors.affiliation: Department of Sexual Medicine, Yijishan Hospital-Wannan Medical College, Wuhu, People's Republic of China.
authors.forename: Yifeng
authors.initials: Y
authors.lastname: Peng
authors.forename: Puneet
authors.initials: P
authors.lastname: Masson
authors.forename: Philip S
authors.initials: PS
authors.lastname: Li
authors.forename: Yue
authors.initials: Y
authors.lastname: Chang
authors.forename: Long
authors.initials: L
authors.lastname: Tian
authors.forename: Richard
authors.initials: R
authors.lastname: Lee
authors.forename: Howard
authors.initials: H
authors.lastname: Kim
authors.forename: David C
authors.initials: DC
authors.lastname: Sokal
authors.forename: Marc
authors.initials: M
authors.lastname: Goldstein
mesh_terms: D000293:Adolescent; D000328:Adult; D000758:Anesthesia / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002648:Child; D002944:Circumcision, Male / Q000379:methods*; D006801:Humans; D007277:Injections, Jet; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine