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Re: Intraoperative intracavernosal liposomal bupivacaine (Exparel) injection does not affect systemic hemodynamics

International Journal of Impotence Research volume 33, pages 378–379 (2021)Cite this article

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Erectile dysfunction affects over 12 million men in the United States [1]. With the recent increase in modifiable risk factors such as diabetes and obesity, there has been an increase in sexual dysfunction [2]. Penile prosthetic implantation has concurrently increased in patients in recent years [3]. Patients undergoing penile prosthetic implantation require pain control, whether post-operatively or peri-operatively [4]. With the recent opioid epidemic, resulting in a 345% increase in opioid-related deaths between 2001 and 2016 [5], there has been an impetus to find alternative pain control strategies for penile implantation [6]. One such pain control strategy is the use of Bupivacaine in the form of a liposomal injectable suspension known as Exparel [7]. Although Bupivacaine has shown promising results for pain control, its safety in patients is still not fully understood.

Taniguchi et al. investigated the effect of intraoperative intracavernosal liposomal bupivacaine (Exparel) injection on systemic hemodynamics [8]. In a retrospective analysis, 56 consecutive patients who underwent Inflatable Penile Prosthesis (IPP) implantation under general anesthesia at a single institution were investigated for their systemic hemodynamics during surgery. Patients who had undergone revision IPP surgery were excluded. All IPPs were implanted through a transverse scrotal approach. Exparel injection was performed about 30 min into surgery, after reservoir placement through a scrotal incision and before corporotomy. A total of 10 mL of 1.3% (13.3 mg/mL) Exparel mixed 1:1 with normal saline were injected intracavernosally. A total of 266 mg of Exparel were administrated. A total of 5 mL of Exparel were also injected in the area around the incision at the end of the procedure. Vital signs were measured continuously during the entire surgical procedure. The median operative time and estimated blood loss were 85 min (IQR: 78–96) and 75 mL (IQR: 29–100), respectively. The preoperative median systolic BP was 131 (122–139) mmHg, which decreased to 98 (90–100) mmHg after anesthesia induction, before the incision was made. Before and after the injection of Exparel, there was no significant change in BP. Systolic and diastolic BPs, at 5-min intervals after surgery was initiated, did not show any significant decrease. Pulse rate and pulse oxygen saturation during immediate preoperative and operative periods was also stable. No arrhythmias or convulsions occurred. The authors concluded that intraoperative intracavernosal Exparel injection did not affect systemic hemodynamics during penile implant surgery.

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Authors and Affiliations

  1. Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA

    Soum D. Lokeshwar, Joshua Bitran & Ranjith Ramasamy

  2. Medical College of Georgia, Augusta, GA, USA

    Sarrah L. Hasanali & Daley S. Morera

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  1. Soum D. Lokeshwar
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Correspondence to Ranjith Ramasamy.

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RR: Coloplast—Consultant, Boston Scientific—Investigator, Endo—Investigator, Advisory Board, Aytu Biosciences—Investigator, Advisory Board, Direx—Investigator.

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Lokeshwar, S.D., Hasanali, S.L., Morera, D.S. et al. Re: Intraoperative intracavernosal liposomal bupivacaine (Exparel) injection does not affect systemic hemodynamics. Int J Impot Res 33, 378–379 (2021). https://doi.org/10.1038/s41443-020-0262-4

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