title: Clinical results for use of local anesthesia with epinephrine in penile nerve block.
abstract: BACKGROUND
  It is widely accepted that local anesthetics with epinephrine should not be used in areas served by terminal vessels. There is no evidence in studies for this in penile surgery, and given the anatomy of the penis, perfusion complications are highly unlikely. The goal of this study was to show that a penile block using a local anesthetic with epinephrine is safe.
  
  
  METHODS
  In a follow-up study between 2005 and 2010, we analyzed 95 patients who got a penile ring block with subcutaneous infusion anesthesia (SIA). The SIA solution consisted of ropivacaine and lidocaine (0.11% and 0.21%) plus epinephrine.
  
  
  RESULTS
  There were no anesthetic complications. Short-term negative postoperative occurrences (<72 hrs.) were swelling (42%), problems with suture material (22%), pain (19%), hematoma and paresthesia (each 13%), erectile dysfunction (12%), small-area skin necrosis after wound healing without requiring further surgery (13%), micturition disorders (7%), and wound infection (6%). Two patients on anticoagulation therapy had postoperative bleeding requiring revision surgery. 5% of the patients were given further analgesic sedation. 19% complained about postoperative pain. Persistent complaints (maximum 6 months) were disturbances of skin sensation (7%), swelling (4%), and redness and micturition disorders (3% each).
  
  
  CONCLUSIONS
  Supplementing a local anesthetic with epinephrine in penis operations has many advantages, including high patient satisfaction, relatively painless infiltration, low complication rates, improved view of the operating field, and an extended effect of anesthetics with a prolonged reduction in pain. Because of the anatomy of the organ, there is no risk of necrosis related to using a subcutaneous penile ring block. Thus the view that epinephrine should not be used in penis procedures is obsolete.
authors.affiliation: Department of Dermatology, Tübingen University, Germany.
authors.forename: Saskia Maria
authors.initials: SM
authors.lastname: Schnabl
authors.forename: Nadine
authors.initials: N
authors.lastname: Herrmann
authors.forename: Daniel
authors.initials: D
authors.lastname: Wilder
authors.forename: Helmut
authors.initials: H
authors.lastname: Breuninger
authors.forename: Hans-Martin
authors.initials: HM
authors.lastname: Häfner
mesh_terms: D000293:Adolescent; D000328:Adult; D000369:Aged, 80 and over; D000772:Anesthesia, Local / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002675:Child, Preschool; D002944:Circumcision, Male / Q000009:adverse effects* / Q000379:methods*; D004359:Drug Therapy, Combination; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D066298:In Vitro Techniques; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000175:diagnosis / Q000517:prevention & control*; D010413:Penis / Q000187:drug effects / Q000294:innervation*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D004837:Epinephrine