(350) Narcotic Requirements and Operative Outcomes of a Pudendal Nerve Block Prior to Primary Inflatable Penile Prosthesis Implantation in a Multiethnic Population

Abstract

Abstract Introduction There are various analgesic regimens for post-operative pain control following inflatable penile prosthesis (IPP) implantation. Specifically, post-operative pain control with opioids is a common practice, but efforts to minimize narcotic usage are vital given the current opioid epidemic in the United States. Pudendal nerve block (PNB) provides regional perineal and penile anesthesia and represents an attractive option to maximize pain control while minimizing post-operative narcotic use. However, there is a paucity of studies describing whether utilization of PNBs decreases intra- and post-operative narcotic requirements following IPP implantation. Objective To determine whether PNB utilization in a multiethnic population undergoing primary IPP implantation can decrease rates of post-operative opiate usage. Secondary objectives were to assess PNB utilization on intra-operative and 30-day safety outcomes. Methods A single institution retrospective study was conducted of patients who underwent primary IPP implantation between December 2015 and February 2022. Demographic data, intra-operative characteristics, and outcome measures were extracted from electronic medical records. Baseline characteristics of PNB (yes or no) were summarized and analyzed using a Student’s t-test, Chi-square test, or Mann-Whitney U for non-normally distributed variables. PNB usage and PACU opioid administration (yes or no) were analyzed using binary logistic regression for univariate and multivariate analysis. Results A total of 363 patients were included, 294 (81.0%) in the PNB group and 69 (19.0%) in the non-PNB group. The majority of patients were of Hispanic race (62.3%). History of chronic pain (17.7% vs. 7.2%, p=0.03) and hyperlipidemia (52.0% vs. 34.8%, p=0.01) were more prevalent in the PNB group. Significantly more IPPs in the PNB group had cylinders measuring 20 centimeters or greater (57.1% vs 41.2, p=0.017). Estimated blood loss of 50ml or greater (43.1% vs. 20.0%, p<0.001), PACU narcotic usage (61.6% vs. 75.4%, p=0.040) and time (minutes) spent in the PACU (144 [111-185] vs. 238 [162-307], p<0.001) were all significantly lower in the PNB group. There were no significant differences in postoperative and 30-day safety outcomes. On univariate analysis, both PNB (OR=0.52, p=0.043) and age above 65 (OR=0.53, p=0.004) were associated with a lower likelihood of receiving opiates in the PACU, while only age remained significant (OR=0.53, p=0.006) on multivariate analysis. Conclusions Pre-operative PNB decreases intra-operative estimated blood loss, post-operative opioid analgesic requirements and time spent in PACU in patients undergoing a primary IPP implantation. Thus, PBN represents a potentially attractive, non-opioid means of analgesia in patients undergoing primary IPP surgery. Disclosure No