Hisanori Taniguchi1, John P Mulhall2. 1. Sexual & Reproductive Medicine Program, Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, NY, USA. 2. Sexual & Reproductive Medicine Program, Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, NY, USA. Electronic address: mulhalj1@mskcc.org.
Abstract
INTRODUCTION: The systemic effect of intracavernosal liposomal bupivacaine (Exparel) injection during inflatable penile prosthesis (IPP) implantation on systemic hemodynamics has not been clarified. AIM: To evaluate whether intraoperative intracavernosal Exparel injection affects systemic hemodynamics. METHODS: 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. MAIN OUTCOME MEASURE: 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. RESULTS: 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. CLINICAL IMPLICATIONS: 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. CONCLUSION: 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.
INTRODUCTION: The systemic effect of intracavernosal liposomal bupivacaine (Exparel) injection during inflatable penile prosthesis (IPP) implantation on systemic hemodynamics has not been clarified. AIM: To evaluate whether intraoperative intracavernosal Exparel injection affects systemic hemodynamics. METHODS: 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. MAIN OUTCOME MEASURE: 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. RESULTS: 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. CLINICAL IMPLICATIONS: 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. CONCLUSION: 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.
Authors: Drogo K Montague; Jonathan P Jarow; Gregory A Broderick; Roger R Dmochowski; Jeremy P W Heaton; Tom F Lue; Aaron J Milbank; Ajay Nehra; Ira D Sharlip Journal: J Urol Date: 2005-07 Impact factor: 7.450
Authors: Gerard D Henry; Edward Karpman; William Brant; Brian Christine; Bryan T Kansas; Mohit Khera; Leroy Jones; Tobias Kohler; Nelson Bennett; Eugene Rhee; Elizabeth Eisenhart; Anthony J Bella Journal: J Urol Date: 2015-08-17 Impact factor: 7.450
Authors: Laurence A Levine; Edgardo F Becher; Anthony J Bella; William O Brant; Tobias S Kohler; Juan Ignacio Martinez-Salamanca; Landon Trost; Allen F Morey Journal: J Sex Med Date: 2016-03-25 Impact factor: 3.802