Serour F, Mori J, Barr J
Division of Pediatric Surgery, E. Wolfson Medical Center, Holon, Israel.
Anesth Analg. 1994 Jul;79(1):129-31. doi: 10.1213/00000539-199407000-00024.
Dorsal penile nerve block (DPNB) is a useful procedure for analgesia in circumcision. It has minor complications and a reported failure rate of from 4% to 6.7%. To evaluate the intraoperative value of additional anesthesia of the perineal nerves--a branch of the pudendal nerve--during circumcision, we conducted a prospective randomized double-blind study on 250 adults. The postoperative period was not studied. The subpubic space technique of DPNB was used. Patients received DPNB (Group I) or DPNB with an additional ventral injection (Group II) for perineal nerve analgesia. Seventeen patients (13.6%) from Group I suffered pain. Of these, nine (7.2%) had discomfort and mild pain but no supplemental analgesia was needed. In the remaining eight patients, however, it was necessary to add local analgesia. This represents a total failure rate of 6.4%. On the other hand, only six patients (4%) in Group II had a mild diffused discomfort with no need for additional local anesthesia (P < 0.01). The average operating time was 12.4 +/- 2.7 min (range 9-22 min) in Group I and 10.7 +/- 1.6 min (range 8-15 min) in Group II (P < 0.001). We think that perineal nerves play an important part in innervation of the penis and must be anesthetized during the penile block.
阴茎背神经阻滞（DPNB）是包皮环切术中一种有效的镇痛方法。它并发症较少，据报道失败率为4%至6.7%。为了评估包皮环切术中额外麻醉阴部神经分支——会阴神经的术中价值，我们对250名成年人进行了一项前瞻性随机双盲研究。未对术后阶段进行研究。采用耻骨下间隙技术进行DPNB。患者接受DPNB（第一组）或DPNB联合额外的腹侧注射（第二组）以进行会阴神经镇痛。第一组有17名患者（13.6%）感到疼痛。其中，9名患者（7.2%）有不适和轻度疼痛，但无需补充镇痛。然而，在其余8名患者中，有必要添加局部镇痛。这代表总失败率为6.4%。另一方面，第二组只有6名患者（4%）有轻度弥漫性不适，无需额外局部麻醉（P<0.01）。第一组的平均手术时间为12.4±2.7分钟（范围9 - 22分钟），第二组为10.7±1.6分钟（范围8 - 15分钟）（P<0.001）。我们认为会阴神经在阴茎的神经支配中起重要作用，在阴茎阻滞期间必须进行麻醉。
