Modified Regional Pudendal Nerve Block Prior to Infrapubic Inflatable Penile Prosthesis Placement

David Fenton, Senthooran Kalidoss, David Velasquez, Stephanie Washington, Alfredo Suarez-Sarmiento, Omer Raheem, Paul Perito

inflatable penile prosthesis, nerve block, regional anesthesia, pudendal block, pain management

This video presents a modified technique for performing a regional pudendal anesthetic nerve block immediately prior to infrapubic inflatable penile prosthesis (IPP) placement. Effective intraoperative and postoperative pain management is critical due to the high sensitivity of penile tissue. With increasing limitations on narcotic pain management, non-narcotic approaches such as local anesthetic blocks are gaining prominence. The technique demonstrated in the video involves a four-step IPP block process: a pudendal nerve block through Alcock’s canal, analgesia of the neurovascular bundle, an incisional block at the surgical site, and a fan block at the reservoir placement site. This is followed by hydrodilation of the corpora using only a lidocaine solution mixed with normal saline, before proceeding with IPP placement. Using a combination of lidocaine and ropivacaine solution, these blocks provide comprehensive analgesia, significantly reducing postoperative pain and facilitating faster recovery. This method offers a safe and effective alternative to narcotic pain management, ensuring patient comfort postoperatively and improving surgical success by minimizing complications related to pain management. The benefits of this anesthetic approach include reduced postoperative discomfort, decreased reliance on narcotics, and overall improved patient recovery experience. In our clinic, postoperative pain scores have been reduced by over 50 percent as a result of this approach to anesthesia, assisting us in becoming a non-narcotic practice.

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