Institutional Policy Changes to Prevent Cardiac Toxicity Associated With Bupivacaine Penile Blockade in Infants.
Dorsal penile nerve block is a widely used method of analgesia for infants undergoing penile surgery. Because of its potency, extended duration of action, and lack of vasoconstriction, bupivacaine remains the most commonly used local anesthetic. Rapid systemic absorption of bupivacaine, however, has been associated with profound central nervous system and cardiovascular side effects, including cardiac arrest. As determined by retrospective medical record analysis, the incidence of complications associated with dorsal penile blockade in our institution was 0.075%. This was significantly higher than previously reported prompting a change in institutional policy that has eliminated penile block complications.
From the *Department of Urology, Boston Children's Hospital, Boston, Massachusetts; and †Department of Anesthesiology, Preoperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.
Richard N
RN
Yu
Constance S
CS
Houck
Alfonso
A
Casta
Richard H
RH
Blum
D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects*; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects*; D066126:Cardiotoxicity / Q000175:diagnosis / Q000517:prevention & control*; D006801:Humans; D007223:Infant; D008297:Male; D009407:Nerve Block / Q000009:adverse effects* / Q000379:methods; D010149:Postoperative Pain / Q000175:diagnosis / Q000517:prevention & control; D010413:Penis / Q000187:drug effects* / Q000294:innervation; D016414:Resuscitation Orders
D000779:Anesthetics, Local; D002045:Bupivacaine