Sexual & Reproductive Medicine Program, Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, NY, USA.
Sexual & Reproductive Medicine Program, Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, NY, USA.
J Sex Med. 2020 Mar;17(3):526-530. doi: 10.1016/j.jsxm.2019.12.017. Epub 2020 Jan 23.
The systemic effect of intracavernosal liposomal bupivacaine (Exparel) injection during inflatable penile prosthesis (IPP) implantation on systemic hemodynamics has not been clarified.
To evaluate whether intraoperative intracavernosal Exparel injection affects systemic hemodynamics.
We studied 56 consecutive patients who underwent IPP implantation under general anesthesia using the transverse scrotal approach. Exparel [10 mL of 1.3% (13.3 mg/mL)] was instilled bilaterally intracavernosally via a 25-gauge needle around 30 min after starting the surgery. All patients graded their postoperative pain using a standard 10-point scale.
Perioperative vital signs at defined time intervals and postoperative pain were monitored. The degree of postoperative pain were analyzed using a standard 10-point scale.
Medians and interquartile ranges (IQRs) of the patients' age [64 years (57.3-69.3)], operation time [85 min (78-96)], and estimated blood loss [75 mL (29-100)] were recorded. Although the median preoperative systolic noninvasively measured blood pressure of 131 mm/Hg (IQR: 122-139) fell by 25% to 98 mm/Hg (IQR: 90-100) (P < .001) after anesthesia started, there was no significant decrease in blood pressure between before and after Exparel injection. The perioperative pulse rate and pulse oximetry oxygen saturation were stable. Neither arrhythmia nor convulsion occurred. Patients reported postoperative pain as 0 (IQR: 0-2.25) on a scale of 0-10.
Intraoperative intracavernosal Exparel injection is safe and effective in patients undergoing IPP implantation surgery.
STRENGTH & LIMITATIONS: This is the first report to describe systemic hemodynamics of intracavernosal Exparel injection. Limitations are lack of blood concentration of Exparel at various time points and long-term follow-up for pain assessment.
Although limited by a lack of the blood concentration of Exparel and short follow-up for pain assessment, we concluded that intraoperative intracavernosal Exparel injection does not affect systemic hemodynamics. Taniguchi H, Mulhall JP. Intraoperative Intracavernosal Liposomal Bupivacaine (Exparel) Injection Does Not Affect Systemic Hemodynamics. J Sex Med 2020;17:526-530.
在可膨胀阴茎假体（IPP）植入过程中，阴茎海绵体内注射脂溶性布比卡因（Exparel）对全身血液动力学的系统影响尚不清楚。
评估术中阴茎海绵体内注射 Exparel 是否会影响全身血液动力学。
我们研究了 56 例连续接受经阴囊横向切口全身麻醉下 IPP 植入术的患者。在手术开始后约 30 分钟，通过 25 号针双侧阴茎海绵体内注入 10 mL 1.3%（13.3 mg/mL）的 Exparel。所有患者均使用标准的 10 分制对术后疼痛进行分级。
在规定的时间间隔监测围手术期生命体征和术后疼痛。使用标准的 10 分制分析术后疼痛程度。
记录患者的年龄[64 岁（57.3-69.3）]、手术时间[85 分钟（78-96）]和估计失血量[75 毫升（29-100）]的中位数和四分位距（IQR）。尽管麻醉开始前，患者术前非侵入性测量的收缩压中位数为 131mmHg（IQR：122-139）下降了 25%，至 98mmHg（IQR：90-100）（P<.001），但在注射 Exparel 前后血压无明显下降。围手术期脉搏率和脉搏血氧饱和度稳定。无心律失常或抽搐发生。患者在 0-10 分的评分上报告术后疼痛为 0（IQR：0-2.25）。
术中阴茎海绵体内注射 Exparel 用于接受 IPP 植入手术的患者是安全有效的。
缺乏不同时间点 Exparel 的血药浓度和长期随访以评估疼痛。
尽管受 Exparel 血药浓度的限制和疼痛评估的随访时间短的限制，但我们的结论是，术中阴茎海绵体内注射 Exparel 不会影响全身血液动力学。
