title: Spermatic cord anesthesia block for scrotal procedures in outpatient clinic setting.
abstract: OBJECTIVE
  We evaluated the safety and effectiveness of spermatic cord anesthetic block (SCAB) as the only method of anesthesia for bilateral simple orchiectomy in an outpatient clinic setting.
  
  
  METHODS
  The study included 141 consecutive bilateral simple orchiectomy (BSO) procedures performed at Atlanta Veterans Affairs Medical Center during a 33-month period. All procedures were performed in an outpatient clinic setting using SCAB as the only method of anesthesia. The anesthetic solution consisted of an equal mixture of 1% lidocaine with epinephrine at 1:100,000 and 0.25% bupivacaine. A 10-point visual analog pain scale was used to assess pain/discomfort at baseline, during SCAB instillation and during BSO. Postoperatively overall patient impression/satisfaction with SCAB as a method of anesthesia was determined.
  
  
  RESULTS
  Nine of the 141 available cases (6.4%) were excluded from study. The remaining 132 cases were included in data analysis. Mean patient age was 75.4 years (range 44 to 86). A total of 76 patients (57.6%) were receiving luteinizing hormone releasing hormone agonist therapy at the time of the procedure. The mean time needed to perform SCAB and BSO was 3.9 (range 2 to 6) and 33.0 minutes (range 12 to 70), respectively. The average volume of anesthetic solution was 20.1 ml per case (range 10 to 32). The mean pain score was 0.36 (range 0 to 8), 1.96 (range 0 to 8) and 0.33 (range 0 to 5) at baseline, and during SCAB and BSO, respectively. Of the patients 102 (77.3%) underwent a painless procedure (pain score = 0), 29 (21.9%) experienced transient pain that was mild in nature (pain score 4 or less) and only 1 (0.7%) had a pain score of 5. Pain scores were similar in patients who were and were not receiving luteinizing hormone releasing hormone agonists at baseline (p = 0.36), during SCAB instillation (p = 0.89) and during BSO (p = 0.36). The overall impression/satisfaction with SCAB as a method of anesthesia was rated as highly satisfactory by 91.7% of patients and satisfactory by 8.3%. There were no intraoperative adverse events related to SCAB.
  
  
  CONCLUSIONS
  SCAB is a simple, safe and highly effective method of anesthesia for scrotal procedures. It allows such procedures to be performed in an outpatient clinic setting, offering convenience and the potential for cost savings.
authors.affiliation: Department of Urology, Atlanta Veterans Affairs Medical Center, Atlanta, Georgia 30322, USA. issa@emory.edu
authors.forename: Muta M
authors.initials: MM
authors.lastname: Issa
authors.forename: Kenneth
authors.initials: K
authors.lastname: Hsiao
authors.forename: Yaser S
authors.initials: YS
authors.lastname: Bassel
authors.forename: Rafael
authors.initials: R
authors.lastname: Bouet
authors.forename: Mark R
authors.initials: MR
authors.lastname: Young
authors.forename: John A
authors.initials: JA
authors.lastname: Petros
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures; D000772:Anesthesia, Local; D006801:Humans; D008297:Male; D008875:Middle Aged; D009919:Orchiectomy; D012611:Scrotum / Q000601:surgery*; D013085:Spermatic Cord