Most often due to poor dorsal penile nerve block technique.
Review of proper location and depth of needle tip (see section Penile Nerve Block Analgesia > Anatomy of Dorsal Penile Nerves).
Avoid moving the needle location during aspiration or injection. Steadying the hand or wrist on the restraining board is helpful.
Use proper technique for the ventral subcutaneous infiltration of the perineal nerves (see section Penile Nerve Block Analgesia > Ventral Subcutaneous Injection Technique).
Wait at least three minutes before proceeding with the circumcision. During this time apply the iodophor ("Betadine") solution and prepare the circumcision pack.
Use adjunctive measures such as 24% sucrose solution on a pacifier for comfort.