Safety and Outcomes of Pediatric Male Circumcisions Using Ring Penile Block Local Anesthesia

Abstract

Male pediatric circumcision is one of the most commonly performed surgical procedures in Libya. Ensuring safe and effective anesthesia with minimal complications is essential, particularly in day-case settings. The aim is To evaluate the safety and complication profile of penile ring block anesthesia in children undergoing circumcision. This prospective observational study was conducted between July 1, 2020, and March 20, 2026, including 2200 male children undergoing circumcision under penile ring block anesthesia. Patients were divided into two age groups: Group A (7 days–6 months, n = 1633) and Group B (>6 months–7 years, n = 567). Parents monitored children for 24 hours postoperatively and reported complications, with additional follow-up thereafter. Outcomes assessed included lethargy, irritability, bradycardia, seizures, apnea, and hematoma formation. Complications were rare and self-limiting. Hematoma formation was reported in 40 patients (1.81%). Lethargy and drowsiness occurred in 9 patients (0.40%), while irritability was reported in 3 patients (0.13%). Bradycardia and seizure activity were each observed in 3 patients (0.13%). A single case (0.04%) of transient apnea occurred immediately following needle insertion. No severe complications or long-term adverse outcomes were identified. Penile ring block anesthesia is therefore a safe and effective technique for pediatric circumcision, with a very low complication rate. It is particularly suitable for high-volume and resource-limited settings