Multimodal analgesia better than opioids at dulling pain after penile implants

Multimodal analgesia (MMA) regimens effectively decrease postoperative pain in patients receiving inflatable penile prosthesis (IPP) implants, a recent study has found.

The study included 203 patients undergoing IPP implantation, of whom 103 (mean age, 62.9±8.8 years) were given an MMA protocol consisting of preoperative and postoperative doses of acetaminophen, gabapentin, and meloxicam or celecoxib, with intraoperative administrations of dorsal and pudendal nerve blocks. The remaining 100 patients (mean age, 64.3±10.1 years) were set as opioid-only controls.

The MMA regimen appeared to be superior. Median visual analogue scale (VAS) scores were significantly lower relative to the opioid group in the postanaesthesia care unit (PACU; 0.0 vs 2.0; p=0.01) and at postoperative day 0 (3.0 vs 4.0; p=0.001) and day 1 (3.0 vs 4.3; p=0.04).

Similarly, fewer narcotics were needed in the MMA vs the opioid group while in the PACU (0.0 vs 4.0 total morphine equivalents; p=0.001) and at postoperative day 0 (7.5 vs 12.5 total morphine equivalents; p<0.001) and day 1 (7.5 vs 13.5 total morphine equivalents; p=0.01).

These advantages extended until the time of discharge, at which point patients treated with the MMA protocol were prescribed significantly fewer narcotics (p<0.001) and were less likely to need refills (p=0.001) than their opioid comparators.

Both treatments were comparably tolerated, with no pain medication-related side effects reported in either arm. This included manifestations such as visual changes, haematomas and acute kidney injuries. The rates of postoperative urinary retention (8.7 percent vs 12.5 percent; p=0.49) and pruritis (0.9 percent vs 3.1 percent; p=0.35) also did not differ between groups.