Long-acting liposomal bupivacaine decreases inpatient narcotic requirements in men undergoing penile prosthesis implantation

Cotta, Brittney; Welliver, Charles; Brahmamdam, Anand; Bednarchik, Cynthia L.; Dynda, Danuta; Köhler, Tobias

doi:10.5152/tud.2016.44442

Cited by 24 publications

(15 citation statements)

References 13 publications

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“…BUP may be administered in 2 ways for implant surgery: by dorsal nerve block or by dipping the implant into BUP during surgery. Dorsal peripheral nerve block using BUP has shown promising results for postoperative pain reduction and control 17, 18. However, the effect of BUP dip on the antibiotic coating on penile implants has not yet been studied.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Bupivacaine on the Efficacy of Antibiotic Coating on Penile Implants in Preventing Infection

et al. 2019

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Background:In an effort to reduce dependence on opioids following inflatable penile prosthesis placement, intra-operative soaking of the implant in Bupivacaine (BUP) has been proposed as part of a multimodal approach to pain control. However, no study has shown if the addition of BUP affects the antimicrobial properties of InhibiZone on AMS700 (Boston Scientific, Marlborough, MA) and/or of antibiotic soaked Titan Coloplast (Coloplast Corporation, Minneapolis, MN). Aim: To determine if BUP alters the zone of inhibition (ZOI) against Staphylococcus epidermidis (S epidermidis) and Escherichia coli (E coli), common gram-positive and gram-negative bacterial causes of infection, respectively, created by InhibiZone coated AMS and/or by antibiotic-soaked Coloplast implant. Methods: S epidermidis and E coli were spread on agar plates. After a 30-minute incubation, four AMS with InhibiZone strips treated with sterile saline or BUP (1.25 mg/mL) were placed on a plate. 4 Coloplast strips were dipped in varying routinely used concentrations of Rifampin (0e10 mg/mL) plus Gentamicin (0e1 mg/mL; rifampin and gentamicin (RþG)) solution with or without BUP. The ZOI for AMS with InhibiZone and Coloplast dipped in antibiotic solution was measured using ImageJ software. Normalized ZOI was calculated as (ZOI area/plate area) Â 100. Unpaired t-test compared the mean ± SD ZOI between BUP and no BUP groups (n ¼ 4/group). Outcomes: The primary outcome of the study was the ZOI against E coli and S epidermidis at 24 and 48 hours. Results: Growth of both S epidermidis and E coli at 24 and 48 hours of incubation was inhibited in both implants and the addition of BUP did not alter the ZOI. Coloplast strips dipped in RþG produced a ZOI in a dose-dependent manner. Interestingly, the ZOI against S epidermidis compared to that of E coli was much wider for both implants. Clinical Implications: This suggests that the use of BUP does not affect the protective effects of antibiotic dips and can potentially be used during penile prosthesis surgery pending clinical trials. Strengths and Limitations: This is the first study to evaluate the effect of BUP on anti-bacterial dips. As with all in vitro analysis, further research must be done to see if these findings hold true in the clinical setting.Conclusions: The addition of BUP does not impede the in vitro antibacterial activity of InhibiZone-coated AMS or RþG-soaked Coloplast. Whether these in vitro findings translate to surgical outcomes needs to be evaluated in future preclinical trials. Lokeshwar SD, Horodyski L, Lahorewala SS, et al. The Effect of

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Section: Discussionmentioning

confidence: 99%

The Effect of Bupivacaine on the Efficacy of Antibiotic Coating on Penile Implants in Preventing Infection

et al. 2019

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“…Likewise, Cotta et al . found that men receiving an extended-release bupivacaine liposomal suspension had significantly decreased narcotic use after implantation relative to those who did not 25 . However, the authors reported significantly higher costs in the extended-release bupivacaine group, which may limit its routine use 25 .…”

Section: Peri-operative Pain Managementmentioning

confidence: 94%

“…found that men receiving an extended-release bupivacaine liposomal suspension had significantly decreased narcotic use after implantation relative to those who did not 25 . However, the authors reported significantly higher costs in the extended-release bupivacaine group, which may limit its routine use 25 . A variety of other local anesthetic approaches (dorsal penile nerve, pudendal nerve, crural, and intracorporal) and medications (lidocaine, bupivacaine, and ropivacaine) have been studied and employed with varying success 24, 26 .…”

Section: Peri-operative Pain Managementmentioning

confidence: 94%

Recent advancements in penile prosthetics

2019

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Since the original inflatable penile prosthesis in the 1970s, several enhancements to penile prosthesis implant design, implant surgical technique, and post-operative care have been developed to increase overall patient (and partner) satisfaction rates. We, in this communication, seek to discuss these advancements and the overall impact in combating erectile dysfunction. As we continue to pursue avenues of effective and definitive treatment modalities for erectile dysfunction refractory to medical therapy, rates of infection and mechanical failure will hopefully continue to decline in the perioperative setting.

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“…The drain is not sewn in and the catheter is accessible through the dressing (a hole cut into the supportive undergarment) which facilitates removal of these items without disturbing the dressing as the patient removes 48 hours after surgery. Use of liposomal bupivacaine during the case aids in pain post procedure and minimizes narcotic use ( 6 ). We give 10 days of post-operative Bactrim although this practice admittedly has no evidence and probably treats the surgeon more than the patient.…”

Section: Post-operative Carementioning

confidence: 99%