https://doi.org/10.4081/aiua.2024.12951

Comparative study between intrathecal fentanyl and dorsal penile nerve block for controlling postoperative pain after inflatable penile prosthesis implantation

Vol. 96 No. 4 (2024)
Submitted: August 21, 2024
Accepted: September 2, 2024
Published: October 29, 2024
Penile prosthesis, penile block, intrathecal fentanyl, postoperative pain
Abstract Views: 749
PDF: 202
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Adel Elatreisy
adel.elatreisy@azhar.edu.eg
https://orcid.org/0000-0001-8407-0564
Urology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Yasser Ahmed
https://orcid.org/0009-0007-5110-727X
Urology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Ahmed Elgarhy
Anesthesia Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Mohamed Hindawy
https://orcid.org/0000-0002-9467-0544
Urology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Tamer Abouelgreed
https://orcid.org/0000-0003-2640-3425
Urology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Ismail Ahmed
https://orcid.org/0000-0001-9636-3946
Anesthesia Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Abdalla Abdalla
https://orcid.org/0009-0001-6647-4335
Anesthesia Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Hany Ramadan
https://orcid.org/0009-0009-8450-2705
Anesthesia Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Mohamed Aboelsuod
https://orcid.org/0000-0001-5277-4153
Anesthesia Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Khaled Shrief
https://orcid.org/0009-0008-5660-2074
Anesthesia Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Ayman Mohamed
https://orcid.org/0009-0009-5264-6317
Anesthesia Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Wael Ibrahim
Anesthesia Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Saeed Abdelhameed
https://orcid.org/0000-0002-9103-6476
Anesthesia Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Mohammad Alghamdi
https://orcid.org/0009-0006-3482-769X
Urology Department, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia.
Mohammed Alzahrani
https://orcid.org/0009-0002-3627-126X
Urology department, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia, Saudi Arabia.
Hamada Youssof
https://orcid.org/0009-0005-9114-0838
Urology Department, Faculty of Medicine, Fayoum University, Egypt.

Objectives: To compare the efficacy of intrathecal fentanyl and dorsal penile nerve block for postoperative pain management in patients undergoing inflatable penile prosthesis (IPP).

Patients and methods: A prospective single-center study included 80 patients amenable to IPP. Patients were divided equally into two groups. Group I included 40 patients who were managed with spinal anesthesia with intrathecal fentanyl before undergoing IPP. Group II comprised 40 patients who received spinal anesthesia with dorsal penile block before IPP. Study groups were compared regarding postoperative VAS (Visual Analog Scale) scores, total narcotics consumption, patient satisfaction levels, and perioperative complications.

Results: The study groups were comparable regarding baseline patients’ criteria. The operative time was comparable between the study groups, with group I and group II having respective median times of 64 minutes (interquartile range: 55-78) and 67 minutes (interquartile range: 56-81) (p = 0.65). Additionally, both groups demonstrated similar distributions in IPP implant cylinder and reservoir size (p = 0.9). Postoperative pain was higher in group I, with a statistically significant difference (p < 0.001). Eight patients in group I (20%) called the physician’s office asking for pain medication, compared to two patients in group II (5%) (p = 0.04). 85% of patients in group II were highly satisfied compared to 50 % in group I (p = 0.003). We reported a 5% complication rate in group I compared to 2.5% in group II (p = 0.6).

Conclusions: The present study found that the dorsal penile nerve block offers superior postoperative pain control and patient satisfaction compared to intrathecal fentanyl for patients undergoing inflatable penile prosthesis insertion.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Crossref
Scopus
Google Scholar
Europe PMC
Burnett AL, Nehra A, Breau RH, et al. Erectile dysfunction: AUA guideline. J Urol 2018; 200:633-41.
Zhu M, Labagnara K, Loloi J, et al. Pudendal nerve block decreases narcotic requirements and time spent in post-anesthesia care units in patients undergoing primary inflatable penile prosthesis implantation. Int J Impot Res 2024; 1-6.
Raynor MC, Smith A, Vyas SN, et al. Dorsal penile nerve block prior to inflatable penile prosthesis placement: a randomized, placebo-controlled trial. J Sex Med. 2012; 9:2975-9.
Xie D, Nicholson M, Azaiza M, et al. Effect of operative local anesthesia on postoperative pain outcomes of inflatable penile prosthesis: prospective comparison of two medications. Int J Impot Res 2018;30:93-96.
Hsu GL, Hsieh CH, Wen HS, et al. Outpatient penile implantation with the patient under a novel method of crural block. Int J Androl 2004; 27:147-51.
Uppal, Vishal FRCA, Retter, Susanne MD, Casey, Margaret MD, et al. Efficacy of Intrathecal Fentanyl for Cesarean Delivery: A Systematic Review and Meta-analysis of Randomized Controlled Trials with Trial Sequential Analysis. Anesthesia & Analgesia 2020;130:111-125.
Carvalho B, Drover DR, Ginosar Y, et al. Intrathecal fentanyl added to bupivacaine and morphine for cesarean delivery may induce a subtle acute opioid tolerance. Int J Obstet Anesth. 2012;21:29-34.
Belzarena SD. Clinical effects of intrathecally administered fentanyl in patients undergoing cesarean section. Anesth Analg. 1992;74:653-657.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240:205-213.
Lucas J, Gross M, Yafi F, et al. A Multiinstitutional Assessment of Multimodal Analgesia in Penile Implant Recipients Demonstrates Dramatic Reduction in Pain Scores and Narcotic Usage. J Sex Med. 2020; 17:518-25.
García Rojo E, Garcíia Gómez B, Manfredi C, al. Efficacy and safety of dorsal penile nerve block before collagenase of clostridium histolyticum injections in peyronie’s disease patients: Results from a prospective pilot study. Andrologia. 2020; 52:e13740.
Nagao K, Ishii N, Miura K, et al. One-day penile prosthesis surgery by penile block. Int J Urol 2000; 7:S56-60.
Ghanem H, Fouad G. Penile prosthesis surgery under local penile block anaesthesia via the infrapubic s space. Int Androl 2000; 23:357-9.
Raynor MC, Smith A, Vyas SN, et al. Dorsal Penile Nerve Block Prior to Inflatable Penile Prosthesis Placement: A Randomized, Placebo-Controlled Trial. J Sex Med 2012; 9:2975-9.
Gürkan Y, Kus¸ A, Aksu C, et al. Ultrasonography- guided penile block for adult penile surgery. Can J Anesth 2016; 63:780-81.
Uppal, Vishal, Retter, Susanne, Casey Margaret, et al. Efficacy of Intrathecal Fentanyl for Cesarean Delivery: A Systematic Review and Meta-analysis of Randomized Controlled Trials with Trial Sequential Analysis. Anesthesia & Analgesia 2020; 130:111-125.
Adel Elatreisy, Urology Department, Faculty of Medicine, Al-Azhar University, Cairo

Urology Department, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia

How to Cite

Elatreisy, A., Ahmed, Y., Elgarhy, A., Hindawy, M., Abouelgreed, T., Ahmed, I., Abdalla, A., Ramadan, H., Aboelsuod, M., Shrief, K., Mohamed, A., Ibrahim, W., Abdelhameed, S., Alghamdi, M., Alzahrani, M., & Youssof, H. (2024). Comparative study between intrathecal fentanyl and dorsal penile nerve block for controlling postoperative pain after inflatable penile prosthesis implantation. Archivio Italiano Di Urologia E Andrologia, 96(4). https://doi.org/10.4081/aiua.2024.12951
Copyright (c) 2024 the Author(s) Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.