Office-based, Minimal-Incision Modified Fenestration Technique for Symptomatic Hydroceles Under Local Anesthesia

Ziegelmann, Matthew; Dodge, Nicole; Alom, Manaf; Wymer, Kevin; Köhler, Tobias; Trost, Landon

doi:10.1016/j.urology.2019.08.055

Cited by 4 publications

(2 citation statements)

References 27 publications

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“…Peri-incisional blocks with LB demonstrate considerable success in controlling post-operative pain for various surgical procedures, although data specific to urology is limited (16,17,35,36). The safety profile of this medication is excellent (37,38).…”

Section: Discussionmentioning

confidence: 99%

“…The authors found that patients who received local anesthesia with LB administered in the corpora cavernosa, within the scrotum, and at the level of the inguinal ring (n=13) used significantly fewer opioids postoperatively when compared to men receiving standard bupivacaine blocks or no local anesthesia (n=24). LB has also been described for use with in-office urologic procedures including hydrocelectomy, testicular sperm extraction, and vasectomy reversal with satisfactory peri-and postprocedural anesthesia reported (36,40). Unfortunately, these descriptions did not quantify postoperative pain control including opioid use.…”

Section: Discussionmentioning

confidence: 99%

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

Britton¹,

Findlay²,

Parikh³

et al. 2021

Transl Androl Urol

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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.

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