Ring block: Difference between revisions

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'''{{FULLPAGENAME}}''' is the name of a nerve blocking local anesthesia procedure that is used to reduce the [[pain]] of non-therapeutic neonatal [[circumcision]].
'''{{FULLPAGENAME}}''' is the name of a nerve blocking local anesthesia procedure that is used to reduce the [[pain]] of non-therapeutic neonatal [[circumcision]]. Ring block was proposed by Broadman et al. (1987) to reduce the [[pain]] if a boy is to be [[circumcised]].<ref name="broadman1987">{{REFjournal
 
Ring block was proposed by Broadman et al. (1987) to reduce, not eliminate, the [[pain]] if a boy is to be [[circumcised]]. Broadman et al. also proposed the use of low-dose intravenous fentanyl for post-operative pain relief.<ref name="broadman1987">{{REFjournal
  |last=Broadman
  |last=Broadman
  |first=
  |first=
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  |title=Post-circumcision analgesia—a prospective evaluation of subcutaneous ring block of the penis
  |title=Post-circumcision analgesia—a prospective evaluation of subcutaneous ring block of the penis
  |trans-title=
  |trans-title=
  |journal= Anesthesiology
  |journal=Anesthesiology
  |location=
  |location=
  |date=1987-09
  |date=1987-09
Line 34: Line 35:
  |issue=3
  |issue=3
  |pages=399-402
  |pages=399-402
  |url=https://watermark.silverchair.com/19870900.0-00019.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAA2EwggNdBgkqhkiG9w0BBwagggNOMIIDSgIBADCCA0MGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMxFrMOebS8rEP05uBAgEQgIIDFHVs3ZBGzFxJFUz193Gh5VvUSksPaLzLU6dU5L2EQJgnacDr_XOHdJdcO_Oq_TEIW5HRrXUntLdOj5TCiscj-0YTzxSn1HIOeiwEsRvxgcDvydGdxx9CNNhvtDd9vTVXaDMhmvD5MydWuNajDw2julVT38WZhtqTJTXdTHzpO-uGyMmGyIxPeZMRaywqpunQZuKISqCEYwXMnrVbYuQo5V87IaG22zZo9FDrlB9IT8CwW5Z9BC_LsniHQe1tVD2z-KtjobunLtW5AzyePo-qm4_vtnbibNAZJR9k0TSAoXoHWKo1-oAPwu8iIOQ0uQjHh3tdZThV1NGTpYsHg6Sn49DtJt-yjHMnwVjUOJ6ihaWCZNp1ujndoBckTu8r2q3_2fz_UziepJotQaA4PFEV4Tdvl4mudDIhbgwwEK6UEmjtJ4GXkdr2fWzH3duJZiAipfTDAQZDMj1-7qgbOe9xl9g8YiPPpcMDYbQi7x-SqPBDlRRNkeN6GcGSC_byXfxwdYMzScQxx2ivoyQFRi-vY53Ehy_94GX3rS-us_wPtH4NuF2RzXsx7W9DTL3VdYrqfWY5g_k0th-EQIMNnjEwMSg_uyh3CVOsotNdEK3ibye67w8t-j7amuBVnBtopycJrK7xfg3PNm6riP88vKV6JIxJp5yWW5dfEI1opG1COpIvLfFPGsaJQxYub50hn8iT8N14tITSLIADGz0y6HPH-uLZ-KtNtoHtXJYG6sVKXRlh0CfvKjOLWXYK-HVQmPeQeyf2MRo21D3QBx6e8oHnhSn7wwaC9ZjkL6uo5sc3NRfim95mgjYEMSxyhN6yxnvQQaJK3su_dSu3y4RURBVHRctrSJQOEROM66aX-G4tWLRi477JklLRVGkakGxtz4g9waMdlxak8qbV7A2FTbjXsPNYNZWOhgdKF58Aas07eRcNtwwhFpRX-Ig8n41M4yU_iouVFHjovpGJeJPXvLrYyCjtiQ4GKPo3hDye-IjQOIe57qAjoNl33PTLpzQAhyUFK2EGLTZYibnBsG9g5Q0aDz3RHoWz
  |url=https://pubs.asahq.org/anesthesiology/article/67/3/399/118178/Post-circumcision-Analgesia-A-Prospective
  |archived=
  |archived=
  |quote=
  |quote=
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}}</ref>
}}</ref>


Ring block is considered to be more effective than [[dorsal penile nerve block]] or [[EMLA]] cream.<ref name="lander1997">{{LanderJ etal 1997}}</ref>
{{Box|Boxtext=<big><b>This procedure does NOT totally eliminate [[pain]]. A baby boy will still experience some [[pain]] and [[trauma]] with this analgesic procedure. Prevention of pain requires protecting a boy from elective neonatal non-therapeutic circumcision. Only boys who are protected from the medically unnecessary, non-therapeutic circumcision surgery experience no [[pain]] or [[trauma]].</b></big>}}


Ring block is considered to be more effective than [[dorsal penile nerve block]] or EMLA cream.<ref name="lander1997">{{REFjournal
The [[penis]] is innervated by both dorsal and perineal nerves,<ref name="cepeda2023">{{REFjournal
  |last=Lander
  |last=Cepeda-Emiliani
  |init=J
  |first=
  |first=Janice
  |init=A
  |author-link=
  |author-link=Alfonso Cepeda-Emiliani
  |last2=Brady-Frerer
  |last2=Gándara-Cortés
  |init2=B
  |first2=
  |first2=Barbara
  |init2=M
  |author2-link=
  |author2-link=
  |last3=Metcalfe
  |last3=Otero-Alén
  |init3=JB
  |first3=
  |first3=James B.
  |init3=M
  |author3-link=
  |author3-link=
  |last4=Nazerali
  |last4=García
  |init4=S
  |first4=
  |first4=Shermin
  |init4=H
  |author4-link=
  |author4-link=
  |last5=Muttit
  |last5=Suárez-Quintanilla
  |init5=S
  |first5=
  |first5=Sarah
  |init5=J
  |author5-link=
  |author5-link=
|last6=García-Caballero
|first6=
|init6=T
|author6-link=
|last7=Gallego
|first7=
|init7=R
|author7-link=
|last8=García-Caballero
|first8=
|init8=R
|author8-link=
  |etal=no
  |etal=no
  |title= Comparison of ring block, dorsal penile nerve block, and topical anesthesia for neonatal circumcision
  |title=Immunohistological study of the density and distribution of human penile neural tissue: gradient hypothesis
  |journal=JAMA
  |trans-title=
  |location=
  |journal= Int J Impot Res
  |date=1997-12-24
  |date=2023-05-02
  |volume=278
  |volume=35
  |issue=24
  |issue=3
  |pages=2157-64
|article=
  |url=http://www.cirp.org/library/pain/lander/
|page=
  |pages=286-305
  |url=https://www.nature.com/articles/s41443-022-00561-9
  |archived=
  |archived=
  |quote=
  |quote=
  |pubmedID=9417009
  |pubmedID=35501394
  |pubmedCID=
  |pubmedCID=
  |DOI=
  |DOI=10.1038/s41443-022-00561-9
  |accessdate=2023-11-24
  |accessdate=2023-12-09
}}</ref>
}}</ref> therefore ring block can never be totally effective.
 
 
{{REF}}
{{REF}}



Latest revision as of 10:16, 9 March 2024

Ring block is the name of a nerve blocking local anesthesia procedure that is used to reduce the pain of non-therapeutic neonatal circumcision.

Ring block was proposed by Broadman et al. (1987) to reduce, not eliminate, the pain if a boy is to be circumcised. Broadman et al. also proposed the use of low-dose intravenous fentanyl for post-operative pain relief.[1]

Ring block is considered to be more effective than dorsal penile nerve block or EMLA cream.[2]


This procedure does NOT totally eliminate pain. A baby boy will still experience some pain and trauma with this analgesic procedure. Prevention of pain requires protecting a boy from elective neonatal non-therapeutic circumcision. Only boys who are protected from the medically unnecessary, non-therapeutic circumcision surgery experience no pain or trauma.


The penis is innervated by both dorsal and perineal nerves,[3] therefore ring block can never be totally effective.

References

  1. REFjournal Broadman LM, Hannallah RS, Belman, AB, Elder PT, Ruttimann, U, Epstein BS. Post-circumcision analgesia—a prospective evaluation of subcutaneous ring block of the penis PDF. Anesthesiology. September 1987; 67(3): 399-402. PMID. DOI. Retrieved 25 November 2023.
  2. REFjournal Lander J, Brady-Frerer B, Metcalfe JB, Nazerali S, Muttit S. Comparison of ring block, dorsal penile nerve block, and topical anesthesia for neonatal circumcision. JAMA. 24 December 1997; 278(24): 2157-64. PMID. Retrieved 24 November 2023.
  3. REFjournal Cepeda-Emiliani A, Gándara-Cortés M, Otero-Alén M, García H, Suárez-Quintanilla J, García-Caballero T, Gallego R, García-Caballero R. Immunohistological study of the density and distribution of human penile neural tissue: gradient hypothesis. Int J Impot Res. 2 May 2023; 35(3): 286-305. PMID. DOI. Retrieved 9 December 2023.