title: Priapism following continuous thoracic epidural anaesthesia: emergency or a benign condition?
abstract: Priapism is a rare complication of epidural anaesthesia, and the pathophysiology is poorly understood. In general, 95% of all priapism episodes are ischemic because of decreased penile blood flow, and therefore requires immediate treatment. A case is reported of a 45-year-old male patient in which a clear relation is demonstrated between continuous thoracic epidural analgesia and priapism after transabdominal nephrectomy. The level of epidural anaesthesia supports the theory that the erection is a consequence of increased penile blood flow, thus a relatively harmless condition. However, confirmation by serial cavernous blood gas analysis or colour duplex ultrasonography is mandatory. Until this hypothesis is confirmed, termination of epidural infusion is advised as a primary treatment.
authors.affiliation: Department of Urology, Martini Hospital, Groningen, The Netherlands.
authors.forename: E E
authors.initials: EE
authors.lastname: Fransen van de Putte
authors.forename: H J K
authors.initials: HJ
authors.lastname: Ananias
authors.forename: N P Tjon Pian
authors.initials: NP
authors.lastname: Gi
authors.forename: H D
authors.initials: HD
authors.lastname: de Boer
mesh_terms: D000767:Anesthesia, Epidural / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects*; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D004630:Emergencies; D006801:Humans; D000077554:Levobupivacaine; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D009294:Narcotics / Q000627:therapeutic use; D009392:Nephrectomy; D010149:Postoperative Pain / Q000188:drug therapy / Q000628:therapy; D010275:Parasympathetic Nervous System / Q000503:physiopathology; D010413:Penis / Q000098:blood supply / Q000294:innervation; D011183:Postoperative Complications / Q000209:etiology*; D011317:Priapism / Q000209:etiology* / Q000503:physiopathology; D017409:Sufentanil / Q000008:administration & dosage / Q000009:adverse effects*; D013564:Sympathetic Nervous System / Q000187:drug effects / Q000503:physiopathology; D013904:Thoracic Vertebrae
chemical_list: D000779:Anesthetics, Local; D009294:Narcotics; D009020:Morphine; D000077554:Levobupivacaine; D017409:Sufentanil; D002045:Bupivacaine