No-Needle Local Anesthesia for the ShangRing Circumcision

This video was produced at Cornell Brady Urology Studio, Center for Male Reproductive Medicine and Microsurgery, Department of Urology, Weill Cornell Medical College. We used a local anesthetic jet injection technique for adult male circumcision.This method eliminates needle use and may decrease the fear of local anesthetic injection used for male circumcision. Materials and Methods: We recruited 60 men seeking voluntary adult male circumcision into the study from June to September 2009. We used a MadaJet® Medical Injector to deliver a high pressure spray of 0.1 ml 2% plain lidocaine solution directly through the penile skin circumferentially around the proximal third of the penis. All men underwent circumcision using the Shang Ring™ and were evaluated for anesthetic safety, efficacy and acceptability. Pain was measured on a visual analog scale. Results: The average volume of 2% lidocaine anesthetic solution delivered by jet injection was 0.1 ml with a mean total of 0.9 ml per circumcision procedure. More than 85% of men did not require supplemental anesthesia. Anesthetic onset required approximately 45 seconds from the time that injections were completed. Mean pain scores for immediate postoperative, 24-hour postoperative, ring removal and post-ring removal events were 0.1, 6.8, 2.2 and 0.9, respectively. In 4 patients (6.67%) mild urethral bleeding resolved with pressure, resulting in technique modification. Conclusions: No-needle jet injection is safe and effective for adult MC. The technique efficiently delivers local anesthesia with rapid onset in men undergoing circumcision. This needle-free approach may enhance the popularity of adult male circumcision. Center for Male Reproductive Medicine and Microsurgery Cornell Institute for Reproductive Medicine Department of Urology Weill Cornell Medical College New York-Presbyterian Hospital