Introduction: Inflatable penile prosthesis (IPP) is the gold standard surgery for refractory erectile dysfunction, though patients can experience significant pain in the postoperative period. Historically, this pain has been managed with opioid medication, which presents additional risk to patients. Pudendal nerve block (PNB) has long been used for intraoperative pain management in IPP, though knowledge of its impact in the postoperative period is limited. Recently, a multimodal analgesic regimen that included a PNB was shown to reduce pain and opioid use following IPP when compared to opioid medication alone. In this video abstract, we describe a simple and safe pudendal nerve block to reduce postoperative pain in patients undergoing IPP. Methods: We retrospectively reviewed 10 patients who underwent a transperineal PNB prior to IPP at our institution. To explore its safety, we documented intraoperative complications and 90-day postop complications. We also documented immediate postop pain using the visual analog scale (VAS), immediate postop opioid administration, and patient-reported pain at the first follow-up visit. Our PNB is a single component of an ERAS protocol, which utilizes pre and postoperative gabapentin, meloxicam, and acetaminophen, in addition to intracavernosal lidocaine. Results: Of the 10 patients we reviewed, 0/10 experienced intraoperative complications and in the 90-day period following surgery 0/10 experienced postop complications. The median VAS pain score in the immediate postop period was 2 (IQR=0 – 3), with 5/10 patients receiving fentanyl for pain control in the PACU. Patients that received fentanyl were on average given two 50mcg doses and had a median VAS pain score of 5 prior to the first dose. 9/10 patients reported no pain at first follow-up, with just a single patient reporting mild pain along the scrotum. Conclusions: In this video abstract, we demonstrate a safe and effective transperineal pudendal nerve block to minimize pain and reduce opioid use in patients following IPP implantation. Our PNB adds minimal pre-op time, does not require ultrasound, and has a low risk of possible complications. For quality control, we reviewed 10 patients who received a PNB before IPP. None of these patients experienced intraoperative or postop complications, demonstrating the safety of the procedure. Additionally, patients reported minimal pain in the immediate postop period and at first follow-up, once again demonstrating the safety and potential efficacy of the nerve block. SOURCE OF Funding: None
