Long-acting liposomal bupivacaine and postoperative opioid use after Peyronie’s disease surgery: a pilot study

Abstract

Background: Novel strategies have been proposed to minimize postoperative opioid use, yet many patients experience significant pain after penile surgery. Our objective was to evaluate postoperative opioid use in patients undergoing penile ring block with long-acting liposomal bupivacaine (LB; Exparel) during surgery for Peyronie's disease (PD). Methods: We identified patients who underwent tunica albuginea plication (TAP) and plaque excision/ grafting (PEG) for PD between July 2019 and September 2020. Intraoperatively, a ring block was administered at the penile base penis with 20 cc of LB. Patients were instructed to use over the counter pain medications as first line treatment for postoperative pain, and opioids were available for severe breakthrough pain as needed [7.5 oral morphine equivalents (OME) =5 mg oxycodone]. Opioid use was assessed during the first five days postoperatively.Results: In total, 28 patients met inclusion criteria including 18/28 (64%) who underwent TAP and 10/28 (36%) who underwent PEG. Median patient age was 56 years (IGR 51;61). Median postoperative 10-point visual analogue pain score was 0 (range 0-3). Duration of penile anesthesia ranged from 1.5-4 days. In total, 9/28 patients (32%) utilized opioids during the first five days postoperatively (range 7.5-75 OME). Two patients (7%) required opioids during the first two days after surgery. 27/28 (96%) were satisfied or highly satisfied with postoperative pain control.Conclusions: Intraoperative penile ring block with LB resulted in excellent pain control with local anesthetic duration of 1.5-4 days. The majority of patients did not require any opioids during the early postoperative period. Further study comparing outcomes with shorter-acting local anesthetics is necessary to balance pain control benefits with additional cost.

Effectiveness of Liposomal Bupivacaine With Bupivacaine Hydrochloride vs Bupivacaine Hydrochloride Alone as a Local Anesthetic for Children Undergoing Ambulatory Urologic Surgery: The Baby ORIOLES Randomized Clinical Trial

“…This study was internally funded, utilizes a clinically relevant efficacy outcome, and addresses limitations of previous single-arm feasibility studies evaluating liposomal bupivacaine in urologic procedures. [9][10][11][12][13] The study arms were well-balanced for characteristics related to postoperative pain. The study boasts relatively high utilization of ketorolac and most patients in both arms had adequate pain relief with acetaminophen and ibuprofen, which underscores the viability of opioid-sparing surgery in pediatric urology.…”

“…7 Preliminary safety data suggest liposomal bupivacaine is safe given as a dorsal penile nerve block in pediatric and adult patients undergoing penile procedures, as incisional infiltration during radical cystectomy, and intracavernosal injection during surgery for Peyronie’s disease. 9-13…”

“…7 Preliminary safety data suggest liposomal bupivacaine is safe given as a dorsal penile nerve block in pediatric and adult patients undergoing penile procedures, as incisional infiltration during radical cystectomy, and intracavernosal injection during surgery for Peyronie's disease. [9][10][11][12][13] To date, no level 1 evidence exists to support the use of liposomal bupivacaine over other local anesthetics in children undergoing ambulatory urologic surgery. The PLAY randomized trial was based solely on safety and pharmacokinetics without attention to comparative clinical efficacy.…”

Narcotic Requirements before and after Implementation of Buccal Nerve Blocks for Buccal Mucosa Graft Harvest: Technique and Retrospective Review

“…One such approach involves the use of regional pre-operative nerve blocks and local anesthesia, which are thought to prevent the transition from acute to chronic neuropathic pain, and limit the pro-inflammatory response to surgery [ 8 , 9 , 10 , 11 ]. Nerve blocks have limited acute post-operative pain in a variety of urologic surgeries, including nephrectomy, percutaneous nephrolithotomy, and tunica plication [ 11 , 12 , 13 , 14 , 15 , 16 , 17 ].…”