Anatomic transperineal pudendal nerve block before penile prosthesis placement to reduce immediate postoperative pain - description and outcomes

Abstract

Introduction: Inflatable penile prosthesis (IPP) is effective in treating refractory erectile dysfunction, however, patients can experience significant pain in the postoperative period. Historically, this pain has been managed with opioid medication, which presents additional risk to patients and necessitates new analgesic methods. Recently, a multimodal analgesic regimen that included a pudendal nerve block (PNB) was shown to reduce pain and opioid use following IPP when compared to opioid medication alone. In this video, we describe a simple and safe pudendal nerve block to reduce postoperative pain in patients undergoing IPP. Patients and surgical procedure: This protocol utilizes anatomic landmarks to safely administer a PNB, adds minimal preoperative time, and does not require ultrasound. We retrospectively reviewed 10 patients who underwent a transperineal PNB prior to IPP implantation at our institution. To explore its safety, we documented intraoperative complications and 90-day postoperative complications. We also documented immediate postoperative pain using the visual analog scale (VAS) and patient-reported pain at the first follow-up visit. Results: No patients experienced any procedural complications or postoperative complications. The median VAS pain score in the immediate postoperative period was 2 (IQR = 0 – 3). The majority of patients (9/10) reported no pain at first follow-up, with just a single patient reporting mild pain along the scrotum. The median time between surgery and the first follow-up was 14 days. Conclusions: In this video, we demonstrate a safe and effective transperineal pudendal nerve block to minimize pain and reduce opioid use in patients following IPP implantation. None of the 10 patients we reviewed experienced intraoperative or postoperative complications, illustrating the safety of the procedure. Patients reported minimal pain in the immediate postoperative period and at first follow-up, demonstrating the safety and potential efficacy of the nerve block.

Keywords

• IPP, Inflatable penile prosthesis
• PNB, Pudendal nerve block
• VAS, Visual analog score