Dorsal penile nerve block prior to inflatable penile prosthesis placement: a randomized, placebo-controlled trial.
BACKGROUND
Dorsal penile nerve block (DPNB) has been previously shown to provide effective analgesia for penile surgeries. To date, few studies have examined the role of DPNB prior to inflatable penile prosthesis (IPP) implantation.


OBJECTIVE
The purpose of this study was to assess the efficacy of local penile nerve block prior to IPP implantation for postoperative pain control.


METHODS
The primary outcome was postoperative pain rated using the visual analog scale (VAS). Secondary outcome measures included total narcotic usage during hospitalization.


METHODS
Institutional Review Board approval was obtained. Patients with erectile dysfunction scheduled for IPP implantation were approached for study participation. Patients were excluded if they had a previous IPP scheduled for revision or replacement or were undergoing additional procedures during the same operative session. Patients were then randomized to either DPNB with 1% lidocaine and 0.5% bupivacaine without epinephrine or injectable saline placebo. Only the resident surgeon assisting in the case was aware of randomization. All procedures were performed by a single surgeon (C.C.C.). Postoperatively, patients were asked to rate their pain using a VAS hourly while in recovery, at 4 hours, and at 23 hours postoperatively. Total narcotic usage was also measured.


RESULTS
A total of 30 patients underwent randomization with 15 patients in each group. Baseline demographic data were similar in each group. There was a significant reduction in pain in the immediate postoperative period and at 4 hours after surgery in the treatment group when compared with placebo (VAS 2.5 vs. 5.3, P = 0.009 at 0 hours; VAS 2.8 vs. 5.1, P = 0.011 at 4 hours). Narcotic usage was similar among both groups. There were no perioperative or early postoperative complications in either group.


CONCLUSIONS
DPNB is safe and effective for reducing pain in the early postoperative period following penile prosthesis implantation.
Division of Urology, The University of North Carolina School of Medicine, Chapel Hill, NC 27599-7235, USA. Mathew_Raynor@med.unc.edu
Mathew C
MC
Raynor
Angela
A
Smith
Sachin N
SN
Vyas
John P
JP
Selph
Culley C
CC
Carson
D000368:Aged; D002045:Bupivacaine; D004311:Double-Blind Method; D006801:Humans; D008012:Lidocaine; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000008:administration & dosage; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000145:classification / Q000175:diagnosis* / Q000517:prevention & control*; D019935:Penile Implantation / Q000379:methods*; D015917:Penile Prosthesis; D010413:Penis / Q000294:innervation* / Q000601:surgery; D011474:Prosthesis Design
D009294:Narcotics; D008012:Lidocaine; D002045:Bupivacaine