Manual for Male Circumcision under Local Anaesthesia

Male circumcision under local anaesthesia
Version 3.1 (Dec09)
Fig. 5.12 Nerve supply to the penis. The twin dorsal penile nerves
emerge from under the pubic bone at the 11 o’clock and 1 o’clock
positions and fan out towards the glans.
Maximum dose of local anaesthetic
The local anaesthetic most often used is 1% plain lidocaine. The
maximum dose that can safely be given is 3 mg per kg of body weight.
The table below gives example volumes so that this maximum dose is
not exceeded.
Examples of maximum safe volume of plain lidocaine (3 mg per kg
body weight).
Patient 0.5%
lidocaine
(5 mg per ml)
3 kg infant
(e.g. 8 days old )
15 kg boy (e.g.
age 4 years)
1% lidocaine
(10 mg per ml)
2% lidocaine
(20 mg per ml)
1.8 ml 0.9 ml Not applicable
9 ml 4.5 ml 2.25 ml
40 kg boy 24 ml 12 ml 6 ml
70 kg man Not applicable 21 ml 10.5 ml
Lidocaine with epinephrine must not be used because there is a risk of
constriction of the blood vessels to the whole penis, which can cause
gangrene and loss of the penis.
The advantage of lidocaine is that it works rapidly. An alternative is a
mixture of 5 ml of lidocaine, 1%, and 5 ml of plain bupivacaine, 0.25%.
This is more expensive but has the advantage of providing longerlasting
anaesthesia (up to 4–5 hours after the operation).
Surgical procedures for adults and adolescents Chapter 5-12