Dorsal Nerve Block Research Articles

Postoperative pain therapy in children: dorsal sciatic nerve block for lower limb surgery

Postoperative pain therapy in children: dorsal sciatic nerve block for lower limb surgery

Outpatient penile implantation with the patient under a novel method of crural block.

Although local anaesthesia for penile implants has been substantially reported, its methodology, simplicity and reliability left room for improvement. We would like to report on an innovative penile crural block using local anaesthesia in patients who underwent penile implantation as outpatient surgery. From March 1987 to March 1991, a total of 21 organically impotent men, aged from 27 to 77 years, received penile prosthesis implantation. All these were performed under pudendal nerve block as an outpatient procedure. From August 1992 to January 2003 a proximal dorsal nerve block with peripenile infiltration and penile crural block was developed to replace the anaesthesia method of pudendal nerve blocks in 137 consecutive patients (aged from 35 to 83 years) undergoing penile implants. The anaesthetic effects and postoperative results with the crural block were very satisfactory. Common immediate side-effects included puncture of the vessels, subcutaneous ecchymosis, transient palpitations and dilation pain, but there were no significant late complications. In the group of pudendal nerve blockage, 42.9% patients (nine of 21) experienced severe aching pain over the perineum for 1-2 weeks postoperatively, whereas the newly developed method of crural block markedly reduced these adverse effects. This new anaesthetic method proved to be reliable, simple, and safe with fewer complications. It offers the advantages of less morbidity, preservation of patient's privacy, reduced adverse effects of anaesthesia, and a more-rapid return to activity with minimal complications.

CORTICAL EVOKED POTENTIALS OF THE DORSAL NERVE OF THE CLITORIS AND FEMALE SEXUAL DYSFUNCTION IN MULTIPLE SCLEROSIS

We evaluated whether disrupting genital central nervous system pathways is associated with subjective reports of sexual dysfunction in women with multiple sclerosis. We performed pudendal somatosensory evoked potential testing in and had sexual questionnaires completed by 14 women with a mean age of 47 years who had multiple sclerosis. The mean expanded disability status score was 5. All but 1 woman reported the desire for sexual intercourse. There was a high rate of dissatisfaction with their sex life and all study participants had concomitant bladder and bowel function problems. The most common sexual complaint was difficult or no orgasm, which was statistically associated with abnormalities or absence of 1 or both pudendal cortical evoked potentials. Fatigue and arousal disorders were also common. Women with multiple sclerosis have a high self-reported rate of sexual dysfunction, which decreases quality of life. Electrodiagnostic data imply that pudendal somatosensory innervation is necessary for normal female orgasmic function. More study is needed to confirm these findings.

The first cut is the deepest? Medicolegal aspects of male circumcision.

The first cut is the deepest? Medicolegal aspects of male circumcision.

Wrestling with the covenant.

Wrestling with the covenant.

Lower extremity blocks for day surgery

A combined block of the lower extremity offers many advantages over spinal or epidural anesthesia, such as less hypotension, no bladder paralysis or postspinal headache, and fewer concerns regarding coagulation problems. Furthermore, the extent of sensory and motor blockade of the lower extremity achieved with a combination of a sciatic and a dorsal lumbar plexus nerve block, by using a peripheral nerve stimulator, is by all means comparable to a central nerve block when used for knee surgery. For the surgery distal to tuberositas tibiae, the popliteal sciatic nerve block, alone or combined with a saphenous nerve block is a reasonable choice; for foot surgery an ankle block is probably the best method, so far as regional anesthesia is considered. The choice of local anesthetics is mostly directed by the duration of the surgery but the attention should be paid to the possibility of systemic toxicity because combined proximal nerve blocks of the lower extremity frequently require amounts approximate to the maximal recommended doses. The increased time investment, the impossibility of blocking all nerves of the lower extremity from one injection site, and certain failure rate which have to be accepted are frequently raised as arguments against the use of peripheral nerve blocks for day surgery. However, by adequate explanation of the procedure to the patient, proper organization of the time-frame table, and home transportation facilities, most of traditional restraints regarding peripheral nerve blocks for ambulatory surgery can be overcome or even acclimated. Copyright © 2000 by W.B. Saunders Company

Out-patient surgery for the correction of penile curvature.

To evaluate an outpatient anaesthetic and surgical procedure for the correction of curvature of the penis. From February 1993 to December 1995, 128 patients (mean age 31 years, range 14-67) with penile curvature (120 with congenital curvature and eight with penile deformity from Peyronie's disease) were treated as out-patients at our institution using a proximal dorsal nerve block and ventral infiltration of the penis as the method of anaesthesia. The degree of deformity, pain and sexual activity were assessed before and after surgery and all patients were followed post-operatively using a questionnaire to determine the outcome and their satisfaction. All the patients were able to leave the hospital shortly after surgery. The follow-up period ranged from 4 to 35 months (mean 17.3); 112 patients (87.5%) reported a satisfactory cosmetic and functional result, while the other 16 patients reported an improvement but had inadequate correction. There were no significant short- or long-term complications; three patients with diabetes developed a hard lump over the operated tunica. This unique operative method provided excellent correction of the deformities, was safe, cost-efficient and durable and could be performed as an out-patient procedure.

Continuous lateral dorsal cutaneous nerve block by a portable disposable pump

Continuous lateral dorsal cutaneous nerve block by a portable disposable pump

Continuous lateral dorsal cutaneous nerve block by a portable disposable pump

Continuous lateral dorsal cutaneous nerve block by a portable disposable pump

Regional anaesthesia for circumcision in adults: a comparative study

Penile block (PB) in adults is not a well-recognized technique. The aim of this study was to compare, in a randomized prospective manner, five different techniques of PB in 250 adults undergoing circumcision with regard to anaesthetic quality, complications and postoperative analgesia. Patients were divided into five groups (50 per group) according to the technique used: Group A--"10, 30-13, 30" approach; Group B--the subpubic approach; Group C--subcutaneous ring block; Group D--a combination of frenulum infiltration and the "10, 30-13, 30" approach; Group E--a combination of frenulum infiltration and the subpubic approach. The number of failed blocks in Groups A and B (41 and 43 respectively) was greater than in Groups C, D and E (2, 3 and 5 respectively) (P < 0.001). The five groups did not differ with regard to adverse effects or time until the onset of postoperative pain when the blocks were successful. It is concluded that good surgical anaesthesia, a low rate of adverse effects and prolonged postoperative analgesia can be achieved by the use of either subcutaneous ring block or a combination of dorsal nerve block (using the "10, 30-13, 30" or the subpubic approach) and infiltration of the frenulum. These approaches to the PB are effective anaesthetic techniques for circumcision in adults.

Post-circumcision analgesia: comparison of topical analgesia with dorsal nerve block using the midline and lateral approaches

Forty-five patients undergoing circumcision were allocated randomly to one of three study groups to compare topical analgesia with dorsal nerve block using the midline or lateral approach. Pain scores, side effects and analgesic requirements were recorded after surgery. Patients who received topical analgesia required significantly more fentanyl and had higher pain scores at the 15-min observation period after operation. Fentanyl requirements and pain scores were similar in patients who received a dorsal nerve block using either the midline or lateral approach. The incidence of side effects after surgery was similar in all three groups.

Dorsal Nerve Block for Management of Intraoperative Penile Erection

Intraoperative penile erection during general anesthesia can delay or prevent the completion of cystoscopic or penile surgical procedures. The dorsal penile nerve block is offered as a treatment for intraoperative erection. Advantages of this technique include less potential for cardiovascular complications and improved postoperative analgesia.

Treatment of Pharmacological Priapism with Phenylephrine

Pharmacological prolonged erections or priapism due to anesthesia were treated in 36 patients with intracorporeal injections of phenylephrine. Detumescence was obtained rapidly in every case and no marked side effect was reported. Considering the possible toxicity of other adrenergic agents, phenylephrine is strongly recommended in the treatment of priapism.

A complication of circumcision and dorsal nerve block of the penis.

A complication of circumcision and dorsal nerve block of the penis.

Neonatal Circumcision and Penile Dorsal Nerve Block—A Painless Procedure

Each monthly issue of Obstetrical & Gynecological Survey presents summaries of the most timely and clinically relevant research being published worldwide. These concise, easy-to-read summaries provide expert insight into how to apply the latest research to patient care. The accompanying editorial commentary puts the studies into perspective and supplies authoritative guidance. The result is a valuable, time-saving resource for busy clinicians.

Neonatal Circumcision and Penile Dorsal Nerve Block—A Painless Procedure

Circumcision is the only surgical procedure, excluding cord-clamping and cutting, which is routinely performed on normal, healthy newborn infants, usually during the first two or three days of life. Apparently no analgesic technique has been described nor suggested in association with neonatal circumcision. This is the first description of a technique of penile dorsal nerve block in neonatal circumcision. In 52 instances using 0.5 ml of 1% lidocaine (Xylocaine) and a 1.2 cm number 27 gauge needle PDNB was successfully and safely introduced with consistent elimination of pain, rendering NC a painless surgical procedure.

Neonatal circumcision and penile dorsal nerve block—a painless procedure

Circumcision is the only surgical procedure, excluding cord-clamping and cutting, which is routinely performed on normal, healthy newborn infants, usually during the first two or three days of life. Apparently no analgesic technique has been described nor suggested in association with neonatal circumcision. This is the first description of a technique of penile dorsal nerve block in neonatal circumcision. In 52 instances using 0.5 ml of 1% lidocaine (Xylocaine) and a 1.2 cm number 27 gauge needle PDNB was successfully and safely introduced with consistent elimination of pain, rendering NC a painless surgical procedure.

Ketamine Treatment Of Priapism

To the Editor.— In the March 20, 1972, issue Dr. Arnold S. Gale reported three cases of penile turgescence treated successfully with 1 mg/lb of ketamine hydrochloride. In two of these cases, an inhalation anesthetic was administered as well. On May 5, 1972, at this institution, a 31-year-old patient with a history of mental illness was admitted with priapism of ten hours' duration. Ketamine hydrochloride, 1 mg/lb administered intravenously, induced a dissociative state without deturgescence. Two additional doses of 0.5 mg/lb were also ineffective, as was a dorsal nerve block of the penis. Spinal anesthesia was subsequently performed with 0.4% tetracaine (Pontocaine), with no deturgescence despite a T-8 sensory level and excellent motor blockade of the perineum and lower extremities. Incidentally, cerebrospinal fluid, collected prior to the anesthetic administration, revealed no laboratory abnormalities. Deturgescence occurred spontaneously the following morning. Further clinical investigation is indeed indicated.