Decreasing Intraoperative Narcotic Use: Pudendal Nerve Block Prior to Inflatable Penile Prosthesis Implantation

Abstract

ABSTRACT Introduction The opioid epidemic has proven to be a public health crisis in the United States over the past two decades and efforts to decrease opioid exposure, and thus risk of dependence, are sorely needed. Objective To determine whether pudendal nerve block (PNB) utilization in the immediate pre-operative setting decreases intra-operative opioid analgesic requirements in veteran patients undergoing a primary inflatable penile prosthesis (IPP) implantation. Methods A retrospective cohort analysis of all patients undergoing a primary IPP implantation between January 2017 and July 2020 at the Charlie Norwood VA Medical Center in Augusta, GA were included. Patients undergoing implant revisions or concurrent procedures were excluded. PNBs were performed in the standard fashion bilaterally with 10 cc of combination 0.25% Marcaine without epinephrine and Solu-Medrol (Methylprednisolone sodium succinate). Univariable and multivariable gamma regression analyses were performed to evaluate the association between PNB utilization and intra-operative opioid analgesic requirements, abstracted from individual patient's anesthesia provider medication administration record. The primary study outcome was intra-operative opioid analgesic requirements, quantified in morphine milligram equivalents (MME), and the secondary outcome was post-operative opioid analgesic requirements. Results The study cohort consisted of 122 patients, 35 (28.7%) of whom underwent a PNB. Twelve (34.3%) and 17 (19.5%) patients in the PNB and non-PNB groups had an active opioid analgesic prescription at the time of their pre-operative visit. Median intra-operative opioid analgesic requirements were significantly lower in the PNB group (16.3 versus 26.0 MME, p=0.036). Receipt of an immediate pre-operative PNB was significantly associated with lower intra-operative opioid analgesic requirements on multivariable (coefficient 0.84, p=0.038) regression analysis. There was no significant difference in post-operative opioid analgesic requirements (37.5 MME in both groups, p=0.15). Conclusions Immediate pre-operative pudendal nerve blocks decrease intra-operative opioid analgesic requirements in veteran patients undergoing a primary inflatable penile prosthesis implantation, and should be considered to decrease intra-operative opioid analgesic requirements. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston Scientific