MP58-11 A MODIFIED PREOPERATIVE SPERMATIC CORD BLOCK PREDICTS SUCCESS FOLLOWING MICROSCOPIC SPERMATIC CORD DENERVATION SURGERY FOR CHRONIC SCROTAL PAIN

Abstract

INTRODUCTION AND OBJECTIVE: Chronic scrotal pain is notoriously difficult to treat. After conservative methods have failed, a microscopic spermatic cord denervation (MSCD) procedure has been shown to be effective, but choosing the appropriate candidate is essential. A spermatic cord block has been reported as a predictor for postoperative success. The traditional block includes an injection inferior/medial to the pubic tubercle but may miss contributors to scrotal pain. Here we utilize a modified cord block that targets the 3 primary locations of Wallerian degeneration: cremasteric muscles, vasal sheath and posterior cord fat, and examine its efficacy in predicting postoperative pain. METHODS: All patients presenting with chronic scrotal pain who failed previous treatments were offered the modified block. This was performed by injecting 10mL 0.25% Marcaine circumferentially around the vas deferens and an additional 10mL anterior/medial to the external ring. Pain was assessed using the Numeric Rating Scale (NRS). Patients with 2019 were included in the study. Preoperative, post-block, and 1-month post-surgical pain was assessed. Laterality, age, prior groin surgery, and post-block pain free period were also record. A multivariate linear regression model was used to determine predictors of surgical success. RESULTS: Thirty consecutive patients were tested with the modified block and subsequently underwent MSCD. Mean age was 47 (20-74). Seven patients (23%) had previously undergone vasectomy and 9 (30%) had undergone hernioplasty. Mean post-block pain free period was 5.6hrs (1.5-24). Mean preoperative NRS was 7 (5-9). Following the block, mean pain reduction was 84%, while pain reduction following surgery was 78% (3 <50%; 6 50-69%; 21 clip_image002.png">70%). On multivariate linear regression analysis, reduction in pain following block was an independent predictor of postoperative success (p<0.001). No other factors, including post-block pain free period were statistically significant. CONCLUSIONS: This modified block technique can be utilized as an effective predictor of success following MSCD. Neither prior groin surgery or post-block pain free period were associated with postoperative pain level. A trial comparing this modified approach to traditional spermatic cord block as a method of selecting the optimal surgical candidate is warranted. Source of Funding: none