Penile ischemia as a complication of epinephrine use in penile nerve block: Truth or myth?

Abstract

The administration of a local anesthetic agent with epinephrine is controversial in penile surgery because of necrosis risk resulting from prolonged vasoconstriction of terminal vessels. We reported a case of an 8-year-old boy suffering from ischemia in the glans of the penis and epidermolysis of the penile skin after circumcision with penile nerve block using anesthetic agents containing epinephrine. The addition of epinephrine to the anesthetic agent (lidocaine) in penile nerve block before circumcision remains controversial. It remains controversial because multiple factors can cause skin necrosis after the circumcision. The adverse effect of epinephrine use in circumcision remains unproven because of a lack of scientific evidence. The administration of epinephrine in penile surgery is the decision of the physician.