Section of Urology, Department of Surgery, Medical College of Georgia-Augusta University, Augusta, GA, USA.
Medical College of Georgia, Augusta, GA, USA.
Int J Impot Res. 2023 Jun;35(4):1-5. doi: 10.1038/s41443-021-00495-8. Epub 2021 Nov 24.
The opioid epidemic has proven to be a public health crisis over the past two decades and efforts to decrease opioid exposure are sorely needed. Our objective was to determine whether pudendal nerve block utilization in the immediate pre-operative setting decreases intra-operative opioid analgesic requirements in veteran patients undergoing a primary inflatable penile prosthesis implantation. We performed a retrospective cohort analysis of all patients undergoing penile prosthesis implantation between January 2017 and July 2020 at the Charlie Norwood Veterans Affairs Medical Center in Augusta, GA. Univariable and multivariable gamma regression analyses were performed to evaluate the association between pudendal nerve block utilization and intra-operative opioid analgesic requirements. The study cohort consisted of 110 patients, 35 (31.8%) of whom underwent a pudendal nerve block. Median intra-operative opioid analgesic requirements were significantly lower in the pudendal nerve block group (16.3 versus 25.8 morphine milliequivalents, p = 0.037). Receipt of the nerve block was associated with significantly lower intra-operative opioid analgesic requirements on multivariable (coefficient 0.84, p = 0.038) regression analysis. There was no significant difference in post-operative opioid analgesic requirements (p = 0.18). In conclusion, pre-operative pudendal nerve blocks decrease intra-operative opioid analgesic requirements in veteran patients undergoing a primary inflatable penile prosthesis implantation.
在过去的二十年中，阿片类药物流行已被证明是一场公共卫生危机，迫切需要减少阿片类药物的暴露。我们的目的是确定在接受原发性可膨胀阴茎假体植入术的退伍军人患者的术前即刻设置中使用阴部神经阻滞是否可以减少术中阿片类镇痛药物的需求。我们对 2017 年 1 月至 2020 年 7 月期间在佐治亚州奥古斯塔查理诺伍德退伍军人事务医疗中心接受阴茎假体植入术的所有患者进行了回顾性队列分析。进行了单变量和多变量伽马回归分析，以评估阴部神经阻滞的使用与术中阿片类镇痛药物需求之间的关联。研究队列包括 110 例患者，其中 35 例（31.8％）接受了阴部神经阻滞。阴部神经阻滞组的术中阿片类镇痛药物需求中位数明显较低（16.3 与 25.8 吗啡毫当量，p=0.037）。多变量回归分析表明，接受神经阻滞与术中阿片类镇痛药物需求显著降低相关（系数 0.84，p=0.038）。术后阿片类镇痛药物需求无明显差异（p=0.18）。总之，术前阴部神经阻滞可降低接受原发性可膨胀阴茎假体植入术的退伍军人患者的术中阿片类镇痛药物需求。
