Acupuncture assisted local anesthesia for penile surgeries

Altered brain functional networks after Quchi (LI 11) acupuncture: An EEG analysis

BACKGROUND

As a unique traditional Chinese medicine therapy, the central effect of acupuncture has received increasing attention. Functional brain networks can provide connectivity information among brain regions.

OBJECTIVE

The study goal is to explore the regulatory effect of acupuncture on the brain functional network.

METHODS

This paper analyzes the electroencephalography (EEG)-based power spectrum and brain functional network elicited by acupuncture at Quchi (LI 11).

RESULTS

The power spectrum results showed that acupuncture at LI 11 decreased the energy in the alpha frequency, mainly in the central region, left parietal lobe, left temporal lobe and left frontal lobe. Moreover, functional brain networks converted from the magnitude-squared coherence matrix in the alpha band are reconstructed. The results show that acupuncture did not alter the basic properties of the brain functional connection network. During acupuncture, the average node degree, average clustering coefficient, and small-world property of the brain functional connection network decreased after acupuncture compared with that before it. However, the average characteristic path length increased after acupuncture compared with before.

CONCLUSION

Acupuncture at LI 11 altered the brain's electrical activity. In the meantime, this acupuncture reduced the network's internal connectivity and information transfer efficiency.

Photobiomodulation enhanced endogenous pain modulation in healthy volunteers

To examine the effects of photobiomodulation (PBM) in healthy volunteers using photonic stimulation of acupuncture points on conditioned pain modulation (CPM), temporal summation of pain (TSP), and offset analgesia (OA), which reflect some aspects of endogenous pain modulation. We included 15 men and 15 women (age, 31.5 [27.3-37.0], body mass index, 25.7 [24.4-27.1], Fitzpatrick skin typing, II: 20, III: 8, IV: 2). CPM, TSP, and OA were evaluated after a sham procedure (control session) and after acupuncture point stimulation (LI4 and LI10 on the non-dominant forearm) using linear polarized near-infrared light irradiation (LPNILI; wavelengths peaked at approximately 1000 nm, output: 1.4 W/cm2, spot diameter: 10 mm, spot size: 1.02 cm2, maximum temperature: 40.5 °C, pulse width: 1 s, frequency: 0.2 Hz) (PBM session). Differences in CPM, TSP, and OA between the two sessions were evaluated by the paired t-test and Fisher's exact test (statistical significance: p < 0.05). Values indicate median [interquartile range]. LPNILI significantly increased CPM in all participants (control session: 12.1 [-4.5-37.4], PBM session: 23.9 [8.3-44.8], p < 0.05) and women (control session: 16.7 [-3.4-36.6], PBM session: 38.7 [24.6-52.1], p < 0.05). The CPM effect increment was significantly higher in women than in men (p = 0.0253). LPNILI decreased TSP in participants with higher TSP ratios (p = 0.0219) and increased OA in participants with lower OA scores (p = 0.0021). LPNILI enhanced endogenous pain modulation in healthy volunteers, particularly in women, as evaluated using CPM. CPM, TSP, and OA evaluations are potentially useful for discriminating PBM responders from non-responders.

Pudendal nerve block prior to inflatable penile prosthesis implantation: decreased intra-operative narcotic requirements

The opioid epidemic has proven to be a public health crisis over the past two decades and efforts to decrease opioid exposure are sorely needed. Our objective was to determine whether pudendal nerve block utilization in the immediate pre-operative setting decreases intra-operative opioid analgesic requirements in veteran patients undergoing a primary inflatable penile prosthesis implantation. We performed a retrospective cohort analysis of all patients undergoing penile prosthesis implantation between January 2017 and July 2020 at the Charlie Norwood Veterans Affairs Medical Center in Augusta, GA. Univariable and multivariable gamma regression analyses were performed to evaluate the association between pudendal nerve block utilization and intra-operative opioid analgesic requirements. The study cohort consisted of 110 patients, 35 (31.8%) of whom underwent a pudendal nerve block. Median intra-operative opioid analgesic requirements were significantly lower in the pudendal nerve block group (16.3 versus 25.8 morphine milliequivalents, p = 0.037). Receipt of the nerve block was associated with significantly lower intra-operative opioid analgesic requirements on multivariable (coefficient 0.84, p = 0.038) regression analysis. There was no significant difference in post-operative opioid analgesic requirements (p = 0.18). In conclusion, pre-operative pudendal nerve blocks decrease intra-operative opioid analgesic requirements in veteran patients undergoing a primary inflatable penile prosthesis implantation.

Enhanced recovery strategies after penile implantation: a narrative review

Optimizing pain management strategies in penile implantation has historically been a challenge to urologists assuming care of patients post-operatively. In addition to the complex pathophysiology of male genital pain, the responsibility of opioid stewardship in the face of the ongoing narcotics epidemic presents its own set of challenges to experienced implanters. Recent innovations in pre- and intra-operative analgesia have provided some improvement in patient-reported pain outcomes. When used together in protocols spanning each phase of operative care, multimodal analgesia (MMA) regimens provide superior patient pain control and successfully decrease opioid usage compared to traditional opioid-based pain control. This review will systematically present literature that discusses interventions in the preoperative and intraoperative spaces aimed at optimally controlling pain. We will also highlight surgical techniques that have been demonstrated to help ameliorate post-operative pain in penile implant recipients. We will discuss the impact of MMA protocols across urology and further explore its larger impact on reducing opioid burden in the ongoing epidemic.

Pain management strategies in penile implantation

The opioid epidemic continues to be a serious public health concern. Many have pointed to prescription drug misuse as a nidus for patients to become addicted to opioids and as such, urologists and other surgical subspecialists must critically define optimal pain management for the various procedures performed within their respective disciplines. Controlling pain following penile prosthesis implantation remains a unique challenge for urologists, given the increased pain patients commonly experience in the postoperative setting. Although most of the existing urological literature focuses on interventions performed in the operating room, there are many studies that examine the role of preoperative adjunctive pain medicine in diminishing postoperative narcotic requirements. There are relatively few studies looking at postoperative strategies for managing pain in prosthetic surgery with follow-up past the immediate hospitalization. This review assess the various strategies employed for managing pain following penile implantation through the lens of the current state of the opioid crisis, thus examining how urologists can responsibly treat pain without contributing to the growing threat of opioid addiction.

Venous ligation: a novel strategy for glans enhancement in penile prosthesis implantation

Although penile implantation remains a final solution for patients with refractory impotence, undesirable postoperative effects, including penile size reduction and cold sensation of the glans penis, remain problematic. We report results of a surgical method designed to avoid these problems. From 2003 to 2013, 35 consecutive patients received a malleable penile implant. Of these, 15 men (the enhancing group) were also treated with venous ligation of the retrocoronal venous plexus, deep dorsal vein, and cavernosal veins. The remaining 20 men formed the control group, treated with only a penile implant. Follow-up ranged from 1.1 to 10.0 years, with an average of 6.7 ± 1.5 years. Although preoperative glanular dimension did not differ significantly between the two groups, significant respective difference at one day and one year postoperatively was found in the glanular circumference (128.8 ± 6.8 mm versus 115.3 ± 7.2 mm and 130.6 ± 7.2 mm versus 100.5 ± 7.3 mm; both P<0.05), radius (38.8 ± 2.7 mm versus 37.1 ± 2.8 mm and 41.5 ± 2.6 mm versus 33.8 ± 2.9 mm; latter P<0.01), and satisfaction rate (91.7% versus 53.3%, P<0.01) as well. Based on our results, selective venous ligation appears to enhance the glans penis dimension in implant patients.