Introduction & Objective :
Inflatable penile prosthesis (IPP) surgery is associated with significant perioperative pain that may reduce patient satisfaction.Though various pain management strategies have been proposed, most implanters manage patients with only prescription opioids. No protocol to date has been implemented and reported for pain management in IPP patients throughout the entire recovery process following surgery. The aim of this study is to develop a multimodal analgesic (MMA) regimen and compare postoperative pain control for MMA patients to a matched cohort of IPP patients managed with an opoid base (OB) regimen.
We retrospectively analyzed our prospectively maintained IPP database from November 2015 through January 2018. The MMA protocol was instituted for all patients beginning June 2017, and these patients were matched in a 1:2 ratio to a cohort of eligible IPP patients managed through an opioid-based (OB) protocol. Only patients receiving a three-piece IPP were included; those with a history of narcotic dependence, neuropathy, or chronic NSAID use were excluded. Postoperative pain scores (visual analog scale, VAS) and opioid usage (total morphine equivalents, TME in mg) were compared temporally in the post-anesthesia care unit (PACU), post-operative day (POD) 0, POD 1, and following discharge.
57 patients were eligible for analysis: 19 (33%) and 38 (66%) in the MMA and OB groups, respectively. Groups were similar in demographics. MMA patients had significantly lower VAS scores in PACU, POD0, or POD1 (mean 0.84 vs 2.97, p=0.01; 2.62 vs 4.73, p=0.003; and 2.26 vs 4.0, p=0.01, respectively) and used fewer narcotics on POD0 (mean 4.08 vs. 13.8 mg TME, p=0.0004) and POD1 (mean 5.05 vs. 25.1 mg TME, p=0.0004). MMA patients were discharged home with fewer narcotics (mean 12.7 vs. 51.3 tabs, p=0.0001), and despite this, the MMA group needed less narcotic medication refills (11% vs. 49%, p=0.007). Neither group experienced a medication-related postoperative adverse event.
In our rigorous assessment of IPP patients, implementation of a novel MMA protocol achieved equivalent and effective pain control, while resulting in substantially fewer narcotics throughout the entire post-operative period following IPP implantation.