Abstract: PD22-02
Sources of Funding: None

Introduction

With the growing epidemic of opioid abuse there is a increased focus on prescribing narcotic analgesics. Surgeons must consider ways to limit these prescriptions. Placement of an inflatable penile prosthesis (IPP) for refractory erectile dysfunction (ED) has high satisfaction rates (92-100% ), but is associated with significant postoperative pain usually requiring opioid analgesics for 7-10 days. Use of bupivacaine liposome injectable suspension has been shown to provide a reduction in postoperative pain and opioid use, although nearly 100 times more expensive than bupivacaine HCl. Our objective was to evaluate the feasibility of a long acting preoperative local anesthetic block in discharging patients on postoperative day (POD) 0 after IPP placement without an opioid prescription and to demonstrate ease of administration.

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 prior to administration. The local anesthetic block was given 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._x000D_

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 opioids. Patients were evaluated on POD 2 and, 9 (11%) patients required a prescription for opioid analgesics. However, at POD 7-10 days, no patients were taking opioids. To reinforce the ease of administration, we are currently analyzing resident administration of the local anesthetic block.

Conclusions

Use of preoperative local penoscrotal block allows for discharge home on POD 0 without opioid analgesics after IPP placement. This local anesthetic mixture is more cost effective than bupivacaine liposome injectable suspensions. With proven efficacy in IPP placemen this local penoscrotal block could be adopted for other penoscrotal surgeries. As opioid addiction and overdose continues to be a public health concern, innovative techniques such as we describe to limit postoperative narcotic requirements are paramount.

Funding

None