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Figures
Fig. 1
Top panel: cross-sectional anatomy at the base of the penis showing the injection site for an UDPB. The UDBP involves a single injection beneath Buck fascia (dotted line). Once Buck fascia is penetrated, local anesthetic readily spreads circumferentially to reach both dorsal and ventral aspects of the penis. Bottom panel: sonogram showing needle tip placement underneath Buck fascia with hypoechoic (black) local anesthetic displacing the CC downward.
Fig. 2
Top panel: ultrasound image of the penis in longitudinal axis (sagittal imaging plane) after local anesthetic for penile block. Buck fascia, symphisis pubis, and CC are labeled for identification. The asterisk indicates the spread of local anesthetic injectate underneath the Buck fascia, above the tunica albuginea of the CC. Bottom panel: ultrasound image of the penis in cross section (coronal imaging plane) after local anesthetic for penile block showing the superficial dorsal vein above Buck fascia with the components of the dorsal neurovascular complex—dorsal nerves, arteries, and deep veins—beneath Buck fascia surrounded by local anesthetic.
Fig. 3
Sagittal plane anatomy of the penis showing the pudendal nerve and its dorsal penile branches. Illustration based on the 20th US edition of Gray's Anatomy of the Human Body, originally published in 1918.
Adequate anesthesia for emergency department management of painful penile conditions such as paraphimosis or priapism is often both technically challenging and inconsistent using traditional landmark-based techniques of the dorsal penile block (DPB). The pudendal nerves branch to form the paired dorsal nerves of the penis providing sensory innervation to the skin of both the dorsal and ventral aspects of the penis. “Blind” DPB techniques tend to rely on subtle tactile feedback from the needle and visual landmark approximation to identify the appropriate subpubic fascial compartment for injection.
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