335 Preoperative administration of a long-acting local anesthetic block to limit narcotic use after inflatable penile prosthesis insertion

Abstract

With the growing epidemic of opioid abuse, surgeons must consider ways to limit prescribing narcotics when possible. Placement of an inflatable penile prosthesis (IPP) for refractory erectile dysfunction (ED) is associated with postoperative pain commonly requiring narcotics. We evaluated the feasibility of a long acting, easy-to-administer preoperative local anesthetic block in discharging patients on postoperative day (POD) 0 after IPP placement without a narcotic prescription. 85 men underwent IPP placement for refractory ED with a local penoscrotal block. A mixture of 0.5% ropivacaine 20cc, 1% lidocaine 20cc, sodium bicarbonate 1cc, and dexamethasone 4mg was prepared and administered using a 22-gauge needle into the pudendal space bilaterally, subcutaneous penile ring, and the external inguinal ring. The IPP was placed using a modified no-touch technique through a subcoronal (88%), infrapubic (11%), or penoscrotal (1%) approach. In addition to local penoscrotal block, 27 (32%) and 58 (68%) patients received general anesthesia and monitored anesthesia care, respectively. The Wong-Baker FACES Visual Analog Scale was used to evaluate pain in the recovery room with an average score of 4.4 (range 0-6). All patients were discharged home on POD 0 with a prescription for Acetaminophen or NSAIDs; none were prescribed narcotics. When evaluated on POD 2, 9 (11%) patients required a narcotic prescription. However, at POD 7-10 days, no patients were taking narcotics.