Penile Subcutaneous Ring Block

Penile ring block Opener

This module describes how to anaesthetise the penis using a subcutaneous ring block.


  1. Penile anaesthesia for minor procedures


  1. Overlying infection


Always verify your patient’s identity and obtain informed consent before proceeding.

How do I explain this procedure?

“I need to give you an injection that will stop your penis from feeling pain while we do the procedure.”

What can my patient expect?

“I am going to prick your skin three times with a needle and inject numbing medication around the base of the penis. Each injection might sting a bit, but after that your whole penis will be numb for a short while. The numbness will wear off by itself.”

What is my patient’s role?

“Let me know if you have any allergies. Fearing blood or needles is normal, but tell me if you have fainted from it. Try to keep still while I give you the injections.”


Penile ring block Equipment

Documentation

  1. Patient notes

Equipment

  1. Alcohol-based hand rub

  2. 10 ml syringe, alcohol swab, aspiration needle (ideally blunt fill), injection needle & choice of

  3. Alcohol swab


Position the patient supine.

Penile ring block Site


Follow medical asepsis with non-sterile gloves.

  1. Perform hand hygiene and don non-sterile gloves.

  2. Clean the skin around the base of the penis with an alcohol swab and allow it to dry.

  3. Draw up

    in a 10 ml syringe.

  4. Insert the needle into the 12 o’clock position at the base of the penis. Guide the needle towards the lateral aspect of the base of the penis.

  5. Aspirate to check for blood.

  6. While withdrawing back to the skin, inject ¼ of the local anaesthetic.

  7. Staying just under the skin, guide the needle to the contralateral side of the penis.

  8. Aspirate to check for blood.

  9. While withdrawing back to the skin, inject ¼ of the local anaesthetic.

  10. Insert the needle into the 3 o’clock position. Guide the needle inferiorly to the

    .

  11. Aspirate to check for blood.

  12. While withdrawing back to the skin, inject ¼ of the local anaesthetic.

  13. Insert the needle into the 9 o’clock position. Guide the needle inferiorly to the 6 o’clock position.

  14. Aspirate to check for blood.

  15. While withdrawing back to the skin, inject ¼ of the local anaesthetic.

  16. Wait 5-10 minutes.

  17. Dispose of medical waste safely.

  18. Record the completion of the procedure in patient notes.


My patient is still feeling pain.

Make sure you wait a full 10 minutes before testing the patient’s sensation. If there is still pain, make sure you injected enough anaesthetic into the entire area. Check the anaesthetic expiry date. Local infection can also reduce the effectiveness of local anaesthetics. Rarely, some patients may be resistant to local anaesthetics.


  1. Minor pain, bleeding & haematoma

  2. Intravascular injection of local anaesthetic

  3. Allergy to local anaesthetic

  4. Penile ischaemia

  5. Local infection

  6. Sharps injury to healthcare provider


  1. Palinrungi MA, Palinrungi ALR, Christeven R, Faruk M. Penile Ischemia as a Complication of Epinephrine Use in Penile Nerve Block: Truth or Myth?. Res Rep Urol. 2021;13:553-555. Published 2021 Aug 4. doi:10.2147/RRU.S308428

  2. Holman JR, Stuessi KA. Adult circumcision. Am Fam Physician. 1999;59(6):1514-1518.

  3. World Health Organization. Circumcision Methods for Adolescent Boys and Men. In: Manual for Male Circumcision Under Local Anaesthesia and HIV Prevention Services for Adolescent Boys and Men. 2009.

  4. Rosen DA, Broadman LM. Ring Block of the Penis: A Proven Addition to Multimodal Pain Relief for Newborn Circumcision. Pediatrics. 2017;140(6):e20172678; DOI: 10.1542/peds.2017-2678