Manual for Male Circumcision under Local Anaesthesia

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Male circumcision under local anaesthesia Version 3.1 (Dec09) SKIN PREPARATION AND DRAPING Skin preparation with povidone iodine Prepare the skin with povidone iodine antiseptic solution, starting with the glans and the shaft of the penis, and moving out to the periphery. Holding the penis with a swab, retract the foreskin in order to clean the glans. The prepared area should include the penis, the scrotum, the adjacent areas of the thighs and the lower part of the abdomen (suprapubic area), so that there is no risk of the surgeon touching unprepared skin during the procedure. If the patient has a history of allergy to iodine, use an alternative solution, such as chlorhexidine gluconate. The solution should remain wet on the skin for at least two minutes. Fig. 5.10 Preoperative skin preparation with povidone iodine Draping Draping provides a sterile operative field and helps prevent contamination of the wound. The edges of the drapes that hang below the operating table are considered to be non-sterile. Scrub and put on gown (if worn) and gloves before covering the patient with sterile drapes. Leave uncovered only the operative area and the areas where the anaesthetic will be administered. A single drape with a hole in it for the penis is better than four drapes secured with towel clips (Fig. 5.11). Surgical procedures for adults and adolescents Chapter 5-10
Male circumcision under local anaesthesia Version 3.1 (Dec09) Fig. 5.11 Draping for male circumcision. The minimum sterile operative field is shown by the dotted lines. ANAESTHESIA Circumcision can be done under general or local anaesthesia. Local anaesthesia is preferred, because it is less risky and less expensive. There are two possible techniques for local penile anaesthesia: the penile nerve block and the ring block. The ring block technique is used for circumcision of adults and adolescents and described below. The penile nerve block is used for circumcision of infants and described in Chapter 6. Penile nerve supply The nerve supply of the penis is the twin dorsal penile nerves. These nerves are located on the top and sides of the penis, at the 11 o’clock and 1 o’clock position near the base of the penis. They fan out towards the glans. Surgical procedures for adults and adolescents Chapter 5-11
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Manual for Male Circumcision under Local Anaesthesia

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