Management of intra operative priapism after spinal anesthesia with intravenous glycopyrrolate and intracorporeal injection of ultra low dose of phenylephrine- A case report

Priapism following neuraxial anesthesia or general anesthesia is a rare but problematic event which may result in delay, complication or even cancellation of scheduled operations in urological endoscopic procedures. We present a case of successful management of intra operative priapism in a 32 years old male under spinal anesthesia posted for Ureteroscopic Lithotripsy (URSL) of bilateral ureteric stone.Different therapies for management of intra operative priapism have been quoted in the past like intracorporeal injection of vasopressors, dorsal penile nerve block, intravenous glycopyrrolate, intravenous ketamine/dexmedetomidine etc. In this case we treated with intravenous glycopyrrolate and intracorporeal injection of ultra low dose phenylephrine.

Comparison between circumferential local anesthesia and dorsal penile nerve block in circumcision procedure

Objectives: To compare circumferential local anesthesia and dorsal penile nerve block with regard to pain control during adult circumcision. Materials and Methods: A randomized, controlled clinical trial was conducted and 30 men were randomly assigned into one of the following groups: circumferential local anesthesia (LA) and dorsal penile nerve block (DNB). Patients in both groups were injected with 0.2 ml/kg of 2% lidocaine without epinephrine before circumcision using the different techniques. During the operation, pain score was evaluated in accordance with the Numerical Rating Scale (NRS) and the data were compared using the Mann-Whitney test. Results: The patients in the LA group felt more pain than those in the DNB group during anesthetic injection (4.73 vs 3.7, p<0.05) but the pain scores were lower than in the DNB group during the outer prepuce incision (0.47 vs 3.93, p<0.05), inner prepuce incision (0.33 vs 1.47, p<0.05) and incision near/at Frenulum (0.33 vs 4.47, p<0.05). Overall pain score was higher in the dorsal penile nerve block group (1.53 vs 2.6, p <0.05). The circumferential local anesthesia is equally effective through all stages of the circumcision whereas the dorsal penile nerve block was not effective at the ventral surface of penis. Conclusion: For pain control in circumcision, circumferential local anesthesia is more effective than dorsal penile nerve block.

Ultrasound-guided penile block for circumcision instead of anatomical landmark method in newborn babies

Background The primary objective of this study is to compare the effectiveness of the newborn’s penile block performed by the surgeon using the classical landmark method and the penile block performed by the anesthesiologist with ultrasound guidance. Results This prospective, single-blinded, randomized clinical study included a total of forty newborn babies scheduled to undergo elective circumcision. The babies were randomized into two treatment groups of ultrasound (US)-guided penile block (group I; n = 20) and classical landmark method dorsal penile nerve block (DPNB) (group II; n = 20) group. Face, Legs, Activity, Cry, Consolability (FLACC) score was used to determine the block efficacy and postoperative pain and analgesic requirements. Intraoperative and postoperative FLACC scores, intraoperative analgesic needs, discharge time, complications, first oral intake time, and parent’s satisfaction were also recorded. FLACC scores were higher in group II than in group I during the intraoperative periods. Heart rate was higher in group II than in group I, at the incision, and during the procedure (P < 0.05). The number of patients requiring fentanyl was higher in group II than in group I (P < 0.01). FLACC scores were statistically higher in the landmark group at arrival in the PACU (P < 0.01) and after 30 min up to 2 h (P < 0.01). Parent’s satisfaction was significantly higher in US group (P < 0.01) Conclusions Intraoperative analgesic needs and pain scores are lower in newborn babies who performed penile block with ultrasound-guided compared to the landmark method.