Comparing Ultrasound-guided and Landmark-based Dorsal Penile Nerve Block Techniques in Pediatric Circumcision: A narrative review

Circumcision is among the most common elective pediatric surgical procedures and is frequently associated with significant perioperative and postoperative pain, posing challenges for effective pain management. Adequate analgesia is therefore essential, and multimodal strategies-including peripheral nerve blocks such as the dorsal penile nerve block (DPNB)-play a critical role in optimizing outcomes. This narrative review seeks to evaluate the comparative efficacy and safety of ultrasound-guided versus landmark-based DPNB techniques in pediatric circumcision. The traditional landmark-based DPNB method has been associated with variable success rates, depending on anatomical variability and clinician experience. In contrast, ultrasound guidance offers real-time visualization of the penile neurovascular structures, enhancing needle placement accuracy, optimizing local anesthetic distribution, and potentially reducing the required anesthetic volume. Several studies suggest that ultrasound-guided DPNB may lead to lower postoperative pain scores and a delayed need for rescue analgesia. However, other research indicates that both approaches may offer comparable analgesic efficacy. Despite this, ultrasound-guided DPNB has demonstrated advantages such as increased precision, a reduced risk of complications, and improved postoperative outcomes. Ultimately, the choice between these techniques should be guided by clinical factors such as resource availability and the operator’s level of proficiency.