Development of an adult circumcision service under local anaesthetic driven by the CoVID-19 pandemic-outcomes and lessons learned
BAUS ePoster online library. Lewis F. 06/22/21; 319135; p9-7
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Ms. Francesca Lewis
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Abstract
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Introduction
The CoVID-19 pandemic has caused severe disruption to elective surgery, and patients with benign conditions have experienced long delays. We identified that adult circumcision could be performed under local anaesthetic (LA) and reviewed the outcome of this change in practice.
Methods
In April 2020, all men on our waiting list for circumcision were contacted and the option of LA circumcision in an out-patient setting explained by the surgeon. A penile block was performed (10ml 1% Lignocaine/10ml 0.5% Marcaine) 5-10 minutes prior to surgery. The sleeve technique was used. A post-operative questionnaire assessed patient experience and pain scores, and EPR records were reviewed for any complications.
Results
A total of 50 circumcisions were attempted by a single surgeon. 47 were completed under LA, while 3 were not started due to high patient anxiety/ongoing penile sensation. The mean age of men who had surgery was 52 vs 26 years (19, 24 & 34) for the 3 in whom the surgeon could not proceed. Pain experienced was inversely proportional to patient age. 34/50 men stated they would recommend LA but 4 would have preferred GA, retrospectively. 3 men had post-op wound issues requiring topical therapies.
Conclusions
LA circumcision can be performed safely in an out-patient setting. Early recognition of the most anxious patients may help to optimise case selection. From our experience to date, it may be that LA circumcision is better suited to older men.
The CoVID-19 pandemic has caused severe disruption to elective surgery, and patients with benign conditions have experienced long delays. We identified that adult circumcision could be performed under local anaesthetic (LA) and reviewed the outcome of this change in practice.
Methods
In April 2020, all men on our waiting list for circumcision were contacted and the option of LA circumcision in an out-patient setting explained by the surgeon. A penile block was performed (10ml 1% Lignocaine/10ml 0.5% Marcaine) 5-10 minutes prior to surgery. The sleeve technique was used. A post-operative questionnaire assessed patient experience and pain scores, and EPR records were reviewed for any complications.
Results
A total of 50 circumcisions were attempted by a single surgeon. 47 were completed under LA, while 3 were not started due to high patient anxiety/ongoing penile sensation. The mean age of men who had surgery was 52 vs 26 years (19, 24 & 34) for the 3 in whom the surgeon could not proceed. Pain experienced was inversely proportional to patient age. 34/50 men stated they would recommend LA but 4 would have preferred GA, retrospectively. 3 men had post-op wound issues requiring topical therapies.
Conclusions
LA circumcision can be performed safely in an out-patient setting. Early recognition of the most anxious patients may help to optimise case selection. From our experience to date, it may be that LA circumcision is better suited to older men.
Introduction
The CoVID-19 pandemic has caused severe disruption to elective surgery, and patients with benign conditions have experienced long delays. We identified that adult circumcision could be performed under local anaesthetic (LA) and reviewed the outcome of this change in practice.
Methods
In April 2020, all men on our waiting list for circumcision were contacted and the option of LA circumcision in an out-patient setting explained by the surgeon. A penile block was performed (10ml 1% Lignocaine/10ml 0.5% Marcaine) 5-10 minutes prior to surgery. The sleeve technique was used. A post-operative questionnaire assessed patient experience and pain scores, and EPR records were reviewed for any complications.
Results
A total of 50 circumcisions were attempted by a single surgeon. 47 were completed under LA, while 3 were not started due to high patient anxiety/ongoing penile sensation. The mean age of men who had surgery was 52 vs 26 years (19, 24 & 34) for the 3 in whom the surgeon could not proceed. Pain experienced was inversely proportional to patient age. 34/50 men stated they would recommend LA but 4 would have preferred GA, retrospectively. 3 men had post-op wound issues requiring topical therapies.
Conclusions
LA circumcision can be performed safely in an out-patient setting. Early recognition of the most anxious patients may help to optimise case selection. From our experience to date, it may be that LA circumcision is better suited to older men.
The CoVID-19 pandemic has caused severe disruption to elective surgery, and patients with benign conditions have experienced long delays. We identified that adult circumcision could be performed under local anaesthetic (LA) and reviewed the outcome of this change in practice.
Methods
In April 2020, all men on our waiting list for circumcision were contacted and the option of LA circumcision in an out-patient setting explained by the surgeon. A penile block was performed (10ml 1% Lignocaine/10ml 0.5% Marcaine) 5-10 minutes prior to surgery. The sleeve technique was used. A post-operative questionnaire assessed patient experience and pain scores, and EPR records were reviewed for any complications.
Results
A total of 50 circumcisions were attempted by a single surgeon. 47 were completed under LA, while 3 were not started due to high patient anxiety/ongoing penile sensation. The mean age of men who had surgery was 52 vs 26 years (19, 24 & 34) for the 3 in whom the surgeon could not proceed. Pain experienced was inversely proportional to patient age. 34/50 men stated they would recommend LA but 4 would have preferred GA, retrospectively. 3 men had post-op wound issues requiring topical therapies.
Conclusions
LA circumcision can be performed safely in an out-patient setting. Early recognition of the most anxious patients may help to optimise case selection. From our experience to date, it may be that LA circumcision is better suited to older men.
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