THE PUDENDAL NERVE BLOCK FOR AMBULATORY UROLOGY: THE OLD IS NEW AGAIN

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety III (MP66)1 Apr 2020MP66-18 THE PUDENDAL NERVE BLOCK FOR AMBULATORY UROLOGY: THE OLD IS NEW AGAIN Chinonyerem Okoro*, Shannon Cannon, Daniel Low, and Thomas Lendvay Chinonyerem Okoro*Chinonyerem Okoro* More articles by this author , Shannon CannonShannon Cannon More articles by this author , Daniel LowDaniel Low More articles by this author , and Thomas LendvayThomas Lendvay More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000941.018AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Caudal epidural analgesia (CEA) is a common analgesic technique performed for pediatric penile surgeries. Recent evidence has implicated an association between hypospadias fistulas and CEA. Risks of CEA include epidural related complications, motor blockade, urinary retention, and is contraindicated in children with lower back abnormalities or coagulopathy. The pudendal nerve block (PNB) is an effective analgesic alternative to CEA and lasts up to 12 hours post-injection. We demonstrate our initial experience employing PNB for ambulatory pediatric urology procedures. METHODS: Using retrospective, non-randomized, time-series, observational real world data, a comparative effectiveness study of CEA and PNB was performed. Patients less than three years old, who underwent circumcision, hypospadias repair, congenital chordee repair, correction of penile angulation, buried penis repair with or without scrotoplasty, meatotomy, or lysis of penile adhesions between January 1, 2015 and September 1, 2019 in an Ambulatory Surgery Center at a single institution were included. Post Anesthesia Care Unit (PACU) pain scores, morphine rescue rates and length of stay (PACU minutes) were determined. RESULTS: A total of 999 patients were identified; 746, 172 and 81 received CEA, ultrasound guided PNB (US PNB) and surgeon administered PNB respectively. Demographic data was comparable between the two cohorts. Anesthetic protocols are in Table 1. There was no special cause variation or difference between the CEA, US PNB and surgeon administered PNB cohorts for PACU pain score (2.49, 2.98, 2.16); morphine rescue rates (2.8%, 6.98%, 2.47%); and PACU length of stay in minutes (57.8, 59.1, 57.3) respectively (Figure 1). CONCLUSIONS: For pediatric penile surgeries, PNB is as effective as CEA. The simplicity and safety of the PNB as well as the equivalent results of our observational study warrants further prospective investigation and may reduce potential morbidity from caudal anesthesia. PNB may have broader application for effective post-operative analgesia in adult penile and urethral surgery. Source of Funding: n/a © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e990-e991 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Chinonyerem Okoro* More articles by this author Shannon Cannon More articles by this author Daniel Low More articles by this author Thomas Lendvay More articles by this author Expand All Advertisement PDF downloadLoading ...