Educational composite image illustrating the ultrasound-guided dorsal penile nerve block (US-DPNB) technique. The upper panels show clinical photographs of the procedural setup, featuring a high-frequency linear ultrasound probe (13-6 MHz) in a sterile sleeve and the insertion of a block needle into the suprapubic/penile base region. The lower section consists of a six-panel ultrasound sequence (A-F) in transverse cross-section. Image A identifies the anatomy: corpus spongiosum (1), corpora cavernosa (2), and Buck’s fascia (3). Images B and C demonstrate the hyperechoic needle advancing toward the target (X) beneath Buck’s fascia. Images D through F show the real-time administration of local anesthetic (LA), visualized as an expanding anechoic/hypoechoic area surrounding the dorsal nerves and vascular structures. This material serves as a clinical guide for regional anesthesia in urological procedures, emphasizing needle trajectory and pharmacological spread relative to penile internal anatomy.

This set of four transverse-view ultrasound images (labeled A-D) illustrates the anatomy and procedural technique for an ultrasound-guided dorsal penile nerve block. Panel A displays the baseline sonoanatomy, identifying the paired corpora cavernosa as central, oval-shaped structures with a medium-gray echotexture, and the smaller, hypoechoic dorsal arteries located inferiorly. Panels B, C, and D demonstrate the dynamic advancement of a hyperechoic (bright) echoic needle using an in-plane approach. The sequence shows the needle entering from the lateral aspect (B), advancing through the fascia to the midline (C), and finally extending beneath the corpora cavernosa toward the contralateral nerve (D). The clinical focus is on visualizing the fascia and vascular structures to ensure precise anesthetic deposition and avoid intravascular injection. This clinical imaging is essential for pediatric anesthesia education regarding safe, regional block techniques for penile procedures.

This composite educational image illustrates the technique for an ultrasound-guided dorsal penile nerve block (DPNB). Panel A is a clinical photograph demonstrating the patient positioning and probe placement. A linear ultrasound transducer is positioned in a coronal plane at the base of the penis, while a 22-gauge needle is being advanced using an in-plane, lateral-to-medial approach. Panels B and C are corresponding ultrasound scans. Panel B shows the pre-injection anatomy of the neurovascular bundle, identifying the deep dorsal penile vein (X) and dorsal penile arteries (Y) located deep to Buck's fascia. The needle tip is visible approaching these structures. Panel C demonstrates the post-injection state, where a well-defined hypoechoic area (LA) indicates the successful distribution of local anesthetic within the neurovascular sheath, surrounding the vein (X) and arteries (Y). This visualization confirms correct drug placement for anesthesia during procedures like circumcision. The content is designed for intermediate medical trainees learning regional anesthesia and pediatric urology techniques.

This clinical procedural photograph demonstrates the technique for a pediatric pudendal nerve block (PNB) using nerve stimulator guidance. The patient is positioned in the lithotomy position, with the perineal region exposed under sterile conditions. A clinician, wearing sterile gloves, is seen performing the block by inserting a specialized nerve stimulator needle (typically 22-24 gauge) into the perineum. The needle is positioned at approximately the 3 o'clock location relative to the anus, midway between the anus and the ischial tuberosity. To the right of the procedural field, a nerve stimulation device is visible, displaying a digital output of '2.3 mA', which is used to localize the nerve by monitoring for motor responses (e.g., penile movement). The image highlights key anatomical landmarks and the precise needle trajectory required for regional anesthesia in the pudendal distribution, commonly used for postoperative pain management in penile surgeries such as hypospadias repair. This content is intended for intermediate to advanced medical training in pediatric anesthesia and pain management.