Manual for Male Circumcision under Local Anaesthesia

Male circumcision under local anaesthesia Version 2.5C (Jan08)
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 5-9
Male circumcision under local anaesthesia Version 2.5C (Jan08)
ANAESTHESIA
Fig. 5.11 Draping for male circumcision. The minimum sterile operative
field is shown by the dotted lines.
Circumcision can be done under general or local anaesthesia. Local
anaesthesia is preferred, because it is less risky and less expensive,
and the man can return home the same day. 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 is described below. The penile nerve block is
used for circumcision of infants, and is 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
Surgical procedures for adults and adolescents Chapter 5-10