141 Use of Dorsal Nerve Block with Bupivacaine Liposome Injectable Suspension (Exparel) for Pain Management Following Three-Piece Penile Prosthesis Surgery

Abstract

INTRODUCTION AND OBJECTIVES: Optimizing postop pain control in men with three-piece penile implant surgery remains an important clinical challenge. Some men with erectile dysfunction (ED) experience significant pain and discomfort for several weeks post-op and require large doses of narcotic analgesics. In 2012, Raynor et al reported on the use of dorsal penile nerve block with 10 ml of both shortacting (lidocaine) and moderately-acting (bupivicaine) local anesthetics to provide effective anesthesia for post-op pain control. To the best of our knowledge, there has been limited reporting of use of dorsal penile nerve block with 20 ml of long-acting intra-operative bupivicaine liposome injectable suspension (Exparel) local anesthesia for post-op pain control. Our objective was to determine in a retrospective study based on post-op narcotic use, the effectiveness of an intra-operative longacting local anesthetic administration as a dorsal nerve penile block would decrease the number of post-op intravenous morphine sulphate administrations and oral narcotic pain pills utilized in patients undergoing three-piece penile implantations. METHODS: 16 men who underwent three-piece penile implantations prior to 2011 at our facility served as historic controls. 28 men who underwent such surgery after 2012 received a dorsal nerve block with 20 ml subcutaneous administered long-acting intra-operative bupivicaine liposome injectable suspension (Exparel) local anesthesia as a dorsal penile nerve block for post-op pain control. All patients were prescribed intravenous morphine sulphate during the overnight stay in the hospital and oral narcotics thereafter following discharge. Patients were contacted and provided the estimated number of narcotic pills utilized. RESULTS: The mean number of total pain administrations taken by the study group over the 4-week post-op period was 8.2 +/5.7 compared with an average of 24.1 +/4.5 (p <0.001) in the control group. Study patients had significantly less post-op pain and ambulated earlier post-op. Several study patients used no pain medications after 1 week of surgery. CONCLUSIONS: This single site retrospective trial has shown that a dorsal nerve block with a long acting bupivicaine liposome injectable suspension (Exparel) local anesthesia can significantly impact long-term post-op pain control. Additional prospective multi-site trials are needed.