O 11. Application of No-needle injection anesthesia on circumcision by Chinese Shang - Ring

Objective: To evaluate the efficacy, safety and acceptability of Noneedle injection anesthesia used in the male circumcision.

Methods: We disinfected the penis and skin of surgical filed, installed high-pressure sterilized Mada Jet (Carlstadt, New Jersey, USA) and injected 4 mL 2% lidocaine into the glass tube, then tighten Mada Jet, pressed the spring handle and attempted to inject anesthetic, once the anesthetic was sprayed out like a thin water column, it was all right. We injected around the skin with an interval at the base of penis or in the lower 1/3. We operated standardized circumcision by Shang-Ring after a satisfactory anesthesia.

Results: A total of 100 males received circumcision by Shang-Ring under no-needle injection anesthesia. Age range, 7-14 years (13 patients), 15-20 years (24 patients), 21-30 years (58 patients), 31-40 years (19 patients), 41-50 years (3 patients), ≥51 years (2 patients), the average age was 23.61 years old. 103 Patients had redundant prepuce and 16 patients had phimosis. Mada Jet sprayed out 0.1 mL 2% lidocaine every time, the average injection points were 8.33, the average injection interval was 7.2 mm, the average onset time of anesthesia was 33.33 s, 0.9 mL anesthetic was totally enough for each patient to receive the circumcision by Shang-Ring. Patient might feel a very light sting when receiving local anesthesia by injection. 88.23% patients could fully tolerate the surgery, 6 patients need 2 or 3 more injections to accomplish the surgery, 8 patients could not tolerate and received subcutaneous injection around the root of penis. Local anesthesia by injection may cause complications like hematoma (5.04%), urinary tract bleeding (3.36%).

Conclusions: No-needle injection anesthesia applied for male circumcision was safe and effective, which may streamline procedures, reduce the onset time of anesthesia and the amount of anesthetic, and avoid the pain and fear of acupuncture anesthesia. To prevent the ecchymosis and hematoma after noneedle anesthesia, the foreskin vascular should not be selected as injection point. To prevent urethral bleeding, the angle of spray nozzle should be 30 degrees towards the urethra or the foreskin should be lifted. Hematoma could self-absorbed in a few days, Urethral bleeding was only haemorrhage from external orifice of urethra, the haemorrhage could be stopped by pressing the urethra of injection point for 1 to 2 minutes. This No-needle injection anesthesia could save the surgical time with Shang-Ring circumcision operation, it was safe and effective, the procedure was simple and easily acceptable, which may help for promoting the male circumcision.