Preoperative administration of a long-acting local anesthetic block to limit narcotic use after inflatable penile prosthesis insertion
Rothwax, J1; Griffith, J1; Valenzuela, R1
1: Icahn School of Medicine at Mount Sinai, United States
Objective: With the growing epidemic of opioid abuse, surgeons must consider ways to limit prescribing narcotics when possible. Placement of an inflatable penile prosthesis (IPP) for refractory erectile dysfunction (ED) is associated with postoperative pain commonly requiring narcotics. We evaluated the feasibility of a long acting, easy-to-administer preoperative local anesthetic block in discharging patients on postoperative day (POD) 0 after IPP placement without a narcotic prescription.
Material and Methods: 85 men underwent IPP placement for refractory ED with a local penoscrotal block. A mixture of 0.5% ropivacaine 20cc, 1% lidocaine 20cc, sodium bicarbonate 1cc, and dexamethasone 4mg was prepared and administered using a 22-gauge needle into the pudendal space bilaterally, subcutaneous penile ring, and the external inguinal ring. The IPP was placed using a modified no-touch technique through a subcoronal (88%), infrapubic (11%), or penoscrotal (1%) approach.
Results: In addition to local penoscrotal block, 27 (32%) and 58 (68%) patients received general anesthesia and monitored anesthesia care, respectively. The Wong-Baker FACES Visual Analog Scale was used to evaluate pain in the recovery room with an average score of 4.4 (range 0-6). All patients were discharged home on POD 0 with a prescription for Acetaminophen or NSAIDs; none were prescribed narcotics. When evaluated on POD 2, 9 (11%) patients required a narcotic prescription. However, at POD 7-10 days, no patients were taking narcotics.
Conclusions: Use of preoperative local penoscrotal block allows for minimized use of narcotics after IPP placement. This practice could be adopted for other penoscrotal surgeries and serve as a model in the effort to limit surgeon contribution to the opioid epidemic.
Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.Go Back