Technique of Dorsal Penile Nerve Block and Ventral Subcutaneous Addition (The "Bartelme Technique"):
Nerve block is performed using 1% Lidocaine without epinephrine.
1. Dorsal penile nerve block (DPNB)
a. Most studied method of analgesia and more effective than EMLA alone according to Cochrane review in 2004.
2. Dorsal penile block (DPNB) plus subcutaneous ventral injection (Dr. Bartelme’s method)
a. Subcutaneous ventral injection was added to supply the ventral analgesia, as it is not achieved by DPNB in 20% of the patients
b. Traditionally this is the standard analgesia used at the University of Michigan Family Medicine residency and described extensively here.
3. Subcutaneous ring block
a. 2 small studies showed the superiority in analgesia to DPNB with similar complication rate (1997 and 1998).
4. Topical EMLA or lidocaine- commonly used as no training required, and provide some relief, but not as effective as DPNB.
Sucrose solution on pacifier – inadequate analgesia by itself.
For an analgesia step-by-step procedure go to: Penile Nerve Block Analgesia.
For a circumcision step-by-step procedure go to: Circumcision with Gomco Clamp.