Use on Epinephrine in Penile Block

Respected Seniors and dear friends

We all have been taught since our undergraduate days that use of epinephrine is to be strictly avoided while giving penile block
However, I was surprised to an article  challenging this concept
I am attaching the article for the kind perusal of all and their comments on the same
I am sure none of us would have deliberately used epinephrine for penile  block
However, it can inadvertently happen
The above mentioned article also quotes another article by Schnabl et al in which they have evaluated results on use f epinephrine for penile block

View DocumentView Document

Comments(3)

  • Venugopal P
    Venugopal P
    06 Aug 2021 10:40:44 AM

    Dear All,

    Gyanendra has brought out an article of some importance on a procedure we commonly perform. This article was published yesterday and one should admire that Gyanendra has brought it to our attention almost immediately.

    The question posed is whether it is safe to use Epinephrine along with Penile Block in commonly performed Penile Surgery. We have all been taught that Epinephrine should not be used along with Local anaesthetic for Penile, Finger and Toe Procedures. We have been following it implicitly. But this wisdom is being questioned of late.

    If you see the pictures provided in the article, I would like the readers to form an opinion as whether they will use Epinephrine along with Local Anaesthetics. The authors mention that the cause of Penile Complications after such a procedure are multifactorial and need not necessarily be due to addition of Lignocaine to the Local Anaesthetic used. In the article provided, an article by Saskia Maria Schnabl* et al (2014) has been quoted (PDF of the article provided). They are of the opinion that Epinephrine can be used safely.

    However much the safety of use of Epinephrine is claimed, if a complication attributable to such a procedure occurs (though maybe rarely), it will be difficult to argue this in a court of law if such an eventuality occurs.

    In Children, especially, a Caudal Block is recommended by many as an alternative to Penile Nerve block. In many children, this is practiced for the needed anaesthesia for the procedure and for postop pain relief after Surgery like Hypospadias repair. M Johr (2010) goes on to say that Penile Surgery without using a regional block should be considered as substandard.

    With warm Regards and thanking Gyanendra yet again,

    Venu

     

    View Document

  • Ravindra Sabnis
    Ravindra Sabnis
    09 Aug 2021 03:51:18 PM

    I agree - whatever article appear in literature - each study we need to take pinch of salt. Thats why too much evidence based medicine is not advisable. Experience counts. If at all you wish to do study to see what is quoted is safe or not, ethics committee will not give permission. 

    Very fact to avoid adrinaline in penile block has come after many bad experiences, it just can't be neglected. but interesting article indeed

  • Ravindra Sabnis
    Ravindra Sabnis
    09 Aug 2021 03:51:24 PM

    I agree - whatever article appear in literature - each study we need to take pinch of salt. Thats why too much evidence based medicine is not advisable. Experience counts. If at all you wish to do study to see what is quoted is safe or not, ethics committee will not give permission. 

    Very fact to avoid adrinaline in penile block has come after many bad experiences, it just can't be neglected. but interesting article indeed

You want to add your comment? Please login
Login