title: Dorsal penile nerve block for robot-assisted radical prostatectomy catheter related pain: a randomized, double-blind, placebo-controlled trial.
abstract: OBJECTIVE
  Following Robotic-Assisted Radical Prostatectomy (RARP) patients routinely have penile pain and urethral discomfort secondary to an indwelling urethral catheter. Our objective was to assess the effect of dorsal penile nerve block with bupivacaine on urethral catheter-related pain after RARP.
  
  
  METHODS
  From 2012-2013, 140 patients with organ-confined prostate cancer were enrolled in an IRB approved double-blinded, randomized control trial comparing a dorsal penile nerve block of bupivacaine versus placebo after RARP performed by a single-surgeon. Patients were asked to complete questionnaires using the Wong-Bakers FACES Pain Rating scale while hospitalized and for 9 days post-operatively, until the catheter was removed. The primary end-points were: catheter-related discomfort, abdominal (incisional) pain, and bladder spasm-related discomfort. Secondary end-points included narcotic and other analgesic usage.
  
  
  RESULTS
  120 patients were randomized to placebo vs. bupivacaine dorsal penile nerve bock. The two arms (n = 56 bupivacaine and n = 60 placebo) did not differ in preoperative, perioperative, or pathological results. There was no difference in narcotic utilization between the two cohorts. Abdominal pain was slightly lower in the bupivacaine arm at 6 hours compared to the placebo arm, but there was no difference in abdominal pain at other time points, and there were no differences in reported catheter-related discomfort or bladder spasm-associated discomfort at any of the measured time points.
  
  
  CONCLUSIONS
  The data does not support the routine use of a dorsal penile nerve block with bupivacaine following RARP.
authors.affiliation: Department of Urology, Columbia University Medical Center, New York, NY 10032 USA.
authors.forename: Aaron C
authors.initials: AC
authors.lastname: Weinberg
authors.affiliation: Department of Urology, Columbia University Medical Center, New York, NY 10032 USA.
authors.forename: Solomon L
authors.initials: SL
authors.lastname: Woldu
authors.affiliation: Department of Urology, Columbia University Medical Center, New York, NY 10032 USA.
authors.forename: Ari
authors.initials: A
authors.lastname: Bergman
authors.affiliation: Department of Biostatistics, Columbia University Medical Center, New York, NY 10032 USA.
authors.forename: Arindam
authors.initials: A
authors.lastname: Roychoudhury
authors.affiliation: Department of Urology, Columbia University Medical Center, New York, NY 10032 USA.
authors.forename: Trushar
authors.initials: T
authors.lastname: Patel
authors.affiliation: Department of Urology, Columbia University Medical Center, New York, NY 10032 USA.
authors.forename: William
authors.initials: W
authors.lastname: Berg
authors.affiliation: Department of Urology, Columbia University Medical Center, New York, NY 10032 USA.
authors.forename: Christel
authors.initials: C
authors.lastname: Wambi
authors.affiliation: Department of Urology, Columbia University Medical Center, New York, NY 10032 USA.
authors.forename: Ketan K
authors.initials: KK
authors.lastname: Badani
keywords: Analgesia; Postoperative pain; Prostate neoplasm; Prostatectomy; Urinary catheterization