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PUDENDAL NERVE BLOCKS IN MEN UNDERGOING ANTERIOR URETHROPLASTY: A CASE SERIES
Author(s): ,
Kalava, A.*
Affiliations:
Tampa General Hospital, Anesthesiology, Tampa, USA
,
Pribish, A.
Affiliations:
University of South Florida- Morsani School of Medicine, Medicine, Tampa, USA
Wiegand, L.
Affiliations:
University of South Florida- Morsani School of Medicine, Urology, Tampa, USA
ESRA Academy. Kalava A. Sep 13, 2017; 190930
Topic: Peripheral Nerve Blocks
Dr. Arun Kalava
Dr. Arun Kalava

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Abstract
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Background and Aims:

The pudendal nerve block (PNB) has applications including diagnosing pudendal neuralgia and providing perineal anesthesia during labor and anorectal and urologic procedures. In women, PNBs are performed via a transvaginal approach using well-defined anatomic landmarks. PNBs are rarely performed and are more technically challenging in men, requiring nerve stimulators, ultrasonography, or fluoroscopy. The efficacy of PNB in men undergoing urologic procedures has not been well studied. We report three cases of PNBs performed using ultrasound guidance and nerve stimulation in men undergoing anterior urethroplasty, all of which achieved adequate postoperative pain control.

Methods:

We obtained written informed consent. After palpating the ischial tuberosity, with the patient in lithotomy position, under general anesthesia, a high frequency ultrasound transducer (15-6 MHz) was moved medial to the ischial tuberosity to identify the internal pudendal artery with color doppler under the sacrotuberous ligament.  A stimuplex needle was then inserted in plane, medial to the pudendal artery stimulating at 1.5 mA and reducing the stimulus to 0.8 mA after eliciting perianal twitch.  After negative aspiration of blood and successful twitch extenuation evidenced by Raj test, 15 mL of 0.5% ropivacaine was injected in 5 ml increments.  The procedure was then repeated contralaterally.

Results:

Two patients reported well-controlled perineal pain at 24 hours postoperatively. One patient reported moderate perineal pain requiring additional analgesia. All patients were discharged on postoperative day 1 without complications.

Conclusions:

This, to our knowledge, is the fist description of pudendal nerve blocks providing effective postoperative pain control in men undergoing anterior urethroplasty.

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