Anesthesia during outpatient circumcision in adults: patientreported outcome

Introduction. Circumcision is one of the most performed surgical procedures worldwide and remains the gold standard treatment for phimosis. The management of perioperative pain is particularly important, as concerns about pain frequently lead patients to decline surgery. The choice of anaesthesia (ranging from topical application to endotracheal general anaesthesia) requires further optimisation, and evaluation of its efficacy and patient satisfaction is essential for improving management of this procedure.

Objective. To compare the effectiveness of infiltration anaesthesia versus dorsal penile nerve block for pain control during circumcision, based on patient-reported outcomes.

Materials & methods. A prospective study was conducted between January 2022 and December 2024, including 173 men with phimosis. All patients underwent standard manual circumcision under outpatient conditions. Patients were randomly allocated into two groups according to the anaesthetic technique used. Group 1 (n = 76) received local infiltration anaesthesia (into the preputial layers), while Group 2 (n = 97) underwent dorsal penile nerve block. Anaesthetic efficacy was assessed using patient-reported pain scores immediately after the procedure, and on postoperative days 1 and 3. The anaesthetic process itself was also evaluated. In addition, the need for supplementary analgesia during the postoperative period was recorded.

Results. The mean patient age was 40.1 ± 1.6 years. Pain intensity during anaesthetic administration was 4.68 ± 0.21 on the VAS in Group 1 compared with 3.1 ± 0.13 in Group 2. During surgery, complete absence of pain (£ 1 on the VAS) was reported by 7.7% of patients in Group 1 (6 out of 76), with a mean score of 3.14 ± 0.17. In Group 2, 94.8% of patients (n = 91) experienced no pain, with a mean score of 1.52 ± 0.14 (p < 0.01). On postoperative day 1, pain intensity was 3.18 ± 0.08 in Group 1 versus 1.9 ± 0.14 in Group 2 (p < 0.01). A higher proportion of patients reported pain scores of 3 or more in Group 1 (14.4%, n = 11) compared with Group 2 (4.13%, n = 4; p < 0.05). Supplementary analgesia (NSAIDs) was required in 50% of patients in Group 1 (n = 38) versus 10.7% in Group 2 (n = 10; p < 0.05). By postoperative day 3, pain intensity was comparable between groups: 1.36 ± 0.1 in Group 1 and 1.34 ± 0.1 in Group 2 (p = 0.9).

Conclusion. Based on patient-reported outcomes, dorsal penile nerve block provides superior analgesia compared with infiltration anaesthesia both intraoperatively and during the early postoperative period in men undergoing circumcision.

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