Anesthesia type

General, Caudal Epidural



Lines and access

PIV x 1


Standard, Temperature

Primary anesthetic considerations

OR and table pre-warmed




Emergence delirium

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Circumcision is a procedure involving the foreskin removal of the penis exposing the glans penis. Indication includes family reasons, phimosis or recurrent balanitis [1][2]. Most circumcisions occur in the newborn nursery performed by pediatrician or obstetrician with different clamps when patients are neonates[1][3]. However, if circumcision is performed in the operating room, the procedure begins with two incisions to remove the penile skin surrounding and covering the glans penis which is the most common method in the operating room[3].

Preoperative management

Operating room setup

  • Set OR temperature to 70o to 75o
  • Underbody bair hugger preheated

Patient preparation and premedication

  • PO midazolam for anxiety in children experiencing separation anxiety
  • PO acetaminophen for pain

Regional and neuraxial techniques

  • Caudal epidural, penile block, pudendal nerve block, or dorsal ring block for analgesia supplemented with general [1][2][4]'
  • Caudal: 0.25% Bupivacaine 1cc/kg

Intraoperative management

Monitoring and access

  • Standard ASA monitors
  • Temperature
  • PIV x 1

Induction and airway management

  • Mask induction with sevoflurane +/- N2O
    • ETT vs LMA
  • IV induction for patients > 10 years old


  • Supine

Maintenance and surgical considerations

  • Maintenance with volatile anesthetics, IV anesthetic or a combination
  • Monitor temperature and ensure large surface areas are covered with warm blankets


  • Emergence delirium

Postoperative management


  • PACU
  • Usually discharged home

Pain management

  • Pain is mild
    • Multimodal
      • PO/PR/IV acetaminophen
      • IV/PO NSAIDs
      • IV/PO opioids
      • Topical local anesthetic
      • Regional block
      • Caudal epidural

Potential complications

  • Infection
  • Hematoma

Procedure variants

Position Supine
Surgical time 30 minutes
EBL Minimal
Postoperative disposition Home
Pain management Mild , multimodal
Potential complications Infection, hematoma


  1. 1.0 1.1 1.2 Anesthesiologist's manual of surgical procedures. Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu (Sixth edition ed.). Philadelphia. 2020. ISBN 978-1-4698-2916-6. OCLC 1117874404. |edition= has extra text (help)CS1 maint: others (link)
  2. 2.0 2.1 A guide to pediatric anesthesia. Craig Sims, Dana Weber, Chris Johnson (2nd ed ed.). Cham. 2020. ISBN 978-3-030-19246-4. OCLC 1117280100. |edition= has extra text (help)CS1 maint: others (link)
  3. 3.0 3.1 Gregory's pediatric anesthesia. Dean B. Andropoulos, George A. Gregory (Sixth edition ed.). Hoboken, NJ. 2020. ISBN 978-1-119-37151-9. OCLC 1137179895. |edition= has extra text (help)CS1 maint: others (link)
  4. Boisvert-Moreau, Frédérique; Turcotte, Bruno; Albert, Natalie; Singbo, Narcisse; Moore, Katherine; Boivin, Ariane (2022-11-17). "Randomized controlled trial (RCT) comparing ultrasound-guided pudendal nerve block with ultrasound-guided penile nerve block for analgesia during pediatric circumcision". Regional Anesthesia & Pain Medicine. doi:10.1136/rapm-2022-103785. ISSN 1098-7339. PMID 36396298 Check |pmid= value (help).