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Dorsal penile block of bupivacaine with adjuvant dexmedetomidine and dexamethasone can safely improve immediate post-operative analgesia and decrease opioid consumption after inflatable penile prosthesis surgery

International Journal of Impotence Research (2025)Cite this article

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Abstract

This single-institution, pre- post-intervention, retrospective study (2019–2021) compared the effect of dorsal penile nerve and ring block of 20 cc bupivacaine (0.25%) with and without dexmedetomidine (70 µg) + dexamethasone (4 mg) on pain scores, and both intra- and postoperative analgesia after primary inflatable penile prosthesis implantation. Dorsal penile nerve and ring block were completed with 10 cc of solution each, immediately before first incision. Anesthesia was not instructed to adjust their anesthetic plan for surgery. The primary outcomes were 11-point ‘0–10’ numerical rating scale pain scores at 0, 2, 6, 12, 18, and 24 h postoperatively and cumulative narcotic use in those time windows. Secondary outcomes included intraoperative narcotic use, intraoperative hypotension (MAP < 60 for >5 min or requiring intervention), and intraoperative bradycardia (HR < 50 for >1 min). 98 patients met inclusion criteria. 32 were in the bupivacaine-only block (pre-intervention) group and 66 were in the bupivacaine, dexmedetomidine, dexamethasone combination block (post-intervention) group. Pain scores at all time points were significantly lower in the post-intervention than in the pre-intervention group (1.1 vs 3.8 p < 0.001, 1.6 vs 3.9 p < 0.001, 3.1 vs 4.9 p = 0.0047, 2.4 vs 4.3 p = 0.0011, 2.9 vs 5.3 p = 0.0047, 2.3 vs 4.4 p < 0.001). Cumulative postoperative narcotic requirement was lower for the post-intervention group (46.8 vs 65.5 mg oral morphine equivalents, p = 0.0067). Secondary outcomes (hypotension and bradycardia) were noted in 16 post-intervention cases, each mild and brief. Intraoperative penile block with bupivacaine and adjuvant dexmedetomidine and dexamethasone can safely improve immediate post-operative analgesia and decrease opioid consumption in the first 24 h.

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Data availability

The de-identified dataset supporting the findings of this study are stored securely at Boston University Medical Center (BUMC). On-site access is granted on a case-by-case basis to researchers who meet the following criteria: (i) affiliated with an accredited institution, (ii) submit a data-use agreement outlining intended analysis, and (iii) receive approval by the BUMC Institutional Review Board (IRB). Requests should be made to the corresponding author (KikuyeS@bu.edu).

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Authors and Affiliations

  1. Boston University Chobanian & Avedisian School of Medicine, Boston, USA

    Kikuye Sugiyama, Robert J. Canelli & Ricardo Munarriz

  2. Boston Medical Center, Boston, USA

    Amanda Swanton, Tejash Shah, Molly Reissmann, Robert J. Canelli & Ricardo Munarriz

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  1. Kikuye Sugiyama
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  2. Amanda Swanton
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Contributions

Initials are used, per guideline Project Idea RM, RC Literature Review KS, RM, Statistics KS, RM, MR Methods RM, KS, MR, AS, TS, Data collection KS, MR, TS, AS Analysis KS, RM, MR, AS Manuscript KS, RM, MR.

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Correspondence to Kikuye Sugiyama.

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The authors declare no competing interests.

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This study was reviewed and approved by the Institutional Review Board of Boston Medical Center. Because the research involved only retrospective chart review of de-identified data and posed minimal risk to participants, the IRB granted a waiver of project-specific written informed consent in accordance with 45 CFR 46.116(d), as general research informed consent was obtained from all subjects previously. All analysis complied with the Health Insurance Portability and Accountability Act (HIPAA) privacy requirements.

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Sugiyama, K., Swanton, A., Shah, T. et al. Dorsal penile block of bupivacaine with adjuvant dexmedetomidine and dexamethasone can safely improve immediate post-operative analgesia and decrease opioid consumption after inflatable penile prosthesis surgery. Int J Impot Res (2025). https://doi.org/10.1038/s41443-025-01195-3

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