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.

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.