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Spermatic Cord Anesthesia Block: An Old Technique Re-imaged

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Jeffrey Gordon
Jeffrey Gordon
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Robert P. Rifenburg
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Spermatic cord anesthesia block (SCAB) is a useful technique for providing anesthesia to males with scrotal pain. This technique has been described and published in the urology and anesthesia literature for more than 40 years. Initially described as a blind injection, anesthesia of the spermatic cord provides pain control to the scrotal contents. The technique can easily be performed under ultrasound guidance by emergency physicians and should be considered a useful option when seeking to provide pain relief to male patients with scrotal pain.
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UC Irvine
Western Journal of Emergency Medicine: Integrating Emergency
Care with Population Health
Title
Spermatic Cord Anesthesia Block: An Old Technique Re-imaged
Permalink
https://escholarship.org/uc/item/7g15v92h
Journal
Western Journal of Emergency Medicine: Integrating Emergency Care with Population
Health, 17(6)
ISSN
1936-9018
Authors
Gordon MD, Jeffrey
Rifenburg DO, Robert P
Publication Date
2016-01-01
DOI
10.5811/westjem.2016.8.31017
Supplemental Material
https://escholarship.org/uc/item/7g15v92h#supplemental
License
CC BY 4.0
Peer reviewed
eScholarship.org Powered by the California Digital Library
University of California
Volume XVII, no. 6: November 2016 811 Western Journal of Emergency Medicine
Case RepoRt
Spermatic Cord Anesthesia Block:
An Old Technique Re-imaged
Jeffrey Gordon, MD
Robert P. Rifenburg, DO
Section Editor: Rick A. McPheeters, DO
Submission history: Submitted May 25, 2016; Revision received July 27, 2016; Accepted August 5, 2016
Electronically published September 13, 2016
Full text available through open access at http://escholarship.org/uc/uciem_westjem
DOI: 10.5811/westjem.2016.8.31017
Presence Resurrection Medical Center, Department of Emergency Medicine,
Chicago, Illinois
Spermatic cord anesthesia block (SCAB) is a useful technique for providing anesthesia to males with scrotal
pain. This technique has been described and published in the urology and anesthesia literature for more
than 40 years. Initially described as a blind injection, anesthesia of the spermatic cord provides pain control
to the scrotal contents. The technique can easily be performed under ultrasound guidance by emergency
physicians and should be considered a useful option when seeking to provide pain relief to male patients
with scrotal pain. [West J Emerg Med. 2016;17(6)811-13.]
CASE REPORT
A 37-year-old male presented to the emergency department
(ED) with a one-week history of left-sided scrotal pain. He
denied previous trauma, associated fever, abdominal pain,
hematuria, or any past genitourinary-related medical history.
He was previously evaluated for a similar complaint ve
days earlier at an outside institution. At that time, his physical
exam was unremarkable and he was treated for presumed
epididymitis with oral antibiotics. However, his symptoms
had not improved with this treatment. Upon arrival to our ED,
his abdomen was soft with no guarding or palpable mass. He
was a circumcised male with normal external genitalia without
notable abnormality to the penis or scrotum. His testicles were
bilaterally descended in normal anatomic position and there was
no inguinal lymphadenopathy or evidence of scrotal cellulitis.
His cremasteric reex was intact. He was however, tender
to palpation along the left testicle/epididymis. A radiology
department ultrasound was performed, which showed mildly
increased vascular ow to the left testes. His pain had not
improved and he was subsequently offered a spermatic cord
anesthesia block (SCAB) for pain management.
DISCUSSION
The SCAB technique has been described multiple times
previously in the literature.
1,2
As early as 1960, Earle published
an article in the American Journal of Surgery discussing local
anesthesia options for inguinal herniorrhaphy,
which described
the technique without naming it as such.3 The spermatic
cord (SC) is a distinct structure in males containing the vas
deferens, which exits the abdomen and extends from the deep
inguinal ring down to each testicle. The cord is covered by the
tunica vaginalis, an extension of the peritoneum. Along with the
vas deferens, contained within the SC are the testicular and
cremasteric arteries, lymphatic vessels, the pampiniform plexus
of veins, and two key nerves – the genital branch of the
genitofemoral nerve and the ilioinguinal nerve. The ilioinguinal
nerve arises off the 12th thoracic and rst lumbar nerve. The
genitofemoral nerve arises off the rst and second lumbar
nerves.2 Combined, these nerves provide enervation to the
cremasteric muscles and sensation to the intrascrotal contents.2 A
correctly performed SCAB provides anesthesia to the scrotal
contents without providing scrotal skin anesthesia.10
Most previously published case series describe a blind
technique whereby the SC is identied by manual palpation.10 A
needle is inserted to deliver anesthetic medication based on tactile
location of the cord. The landmark for this procedure is
classically described as being a point 1 cm below and 1 cm
medial to the pubic tubercle.4 The technique as described by Kaye
et al was proposed to facilitate vasovasotomy, hydrocelectomy,
spermatocelectomy, and orchiectomy4 and has been generally
viewed as a successful technique.2 Both Kaye and Cassady
describe a technique involving three needle passes at slightly
different angles to the SC with total deposition of 12-15ml of
local anesthetic.2,4 Subsequent articles have commented on the
difculty in palpating and identifying the pubic tubercle,9
especially in patients with protuberant abdomens or large pannus
Western Journal of Emergency Medicine 812 Volume XVII, no. 6: November 2016
Spermatic Cord Anesthesia Block Gordon et al.
folds. These case reports and studies involving SCAB have
primarily been published in the urology and anesthesia literature.
The SCAB technique has been proposed as a cost-savings
option to facilitate various surgical procedures including
outpatient orchiectomy5 and vasectomy reversal.6 It has also been
proposed for treatment of SC torsion prior to manual reduction.7,8
Kiesling et al report a case series of 15/16 successful detorsions
following SCAB.8 Some reported advantages to this technique
include the lack of need for general anesthesia and its attendant
potential complications.4 Additionally, patients require less
post-operative pain control as the block serves as its own
anesthetic resulting in an overall cost savings for the technique
compared with general anesthesia.5 Reported complications of the
blind injection technique include vascular injury to the testicular
artery6 or possible intra-arterial injection and/or damage to the
deferent ducts.9 As the availability of ultrasound (US) for
emergency physicians continues to increase, SCAB under
ultrasound (US) guidance is a simple technique that can provide
immediate anesthesia for patients with testicular and scrotal pain.
The SC block performed on our patient was achieved with a
multifrequency linear L8-3 probe on our ZONARE Z1 Ultra
ultrasound machine. The technique involved rst identifying the
spermatic cord and cremasteric artery. The probe was positioned
between the pubic tubercle and the anterior superior iliac spine on
the affected side (Figure 1). Once the SC was identied (Figure
2), 5ml of 1% xylocaine and 5 ml of 0.5% bupivacaine were
combined in a single syringe with a #21 gauge 1.5-inch needle.
The skin site was prepared and draped and the SC was palpated.
The SC location was conrmed by bedside US in both the
longitudinal and transverse planes. Under direct US visualization,
the needle was positioned in the SC, avoiding the vascular
structures (Figure 3). Approximately 8 cc’s of the anesthetic
solution was injected in and directly around the SC (Figure 4).
The patient reported nearly immediate symptomatic relief without
bleeding at the injection site. The patient was monitored for pain
relief and was ready for discharge within 15 minutes of nerve
block completion. A subsequent follow-up phone call conrmed
that our patient did not have any delayed complications nor did
he experience a recurrence of his pain.
We present the technique of SCAB under ultrasound
guidance. This technique has been described for more than
40 years and has been shown to be an effective adjunct for
addressing pain in patients with testicular and/or scrotal
complaints. The rst step in the management of testicular pain
without acute surgical ndings remains conservative in nature.
Consideration should include the use of scrotal elevation,
NSAIDS, and cold compresses. Additionally, US-guided SCAB
is a simple effective adjunct. As US availability in the ED is
readily accessible, this technique is easily and safely performed
by emergency physicians and should be considered a viable
option for treating testicular pain in the ED.
Figure 1. Initial positioning of the ultrasound (US) probe to locate
the spermatic cord.
Figure 2. Transverse view of the spermatic cord. Figure 3. Identication of adjacent vascular structure. Transverse
view showing the spermatic cord and adjacent cremasteric artery.
Volume XVII, no. 6: November 2016 813 Western Journal of Emergency Medicine
Gordon et al. Spermatic Cord Anesthesia Block
Figure 4. Coronal view. Sonographic anatomy of the spermatic
cord (SC) and anesthesia (AN) solution deposited adjacent to the
cord.
Address for Correspondence: Jeffrey Gordon, MD, Presence
Resurrection Medical Center, Department of Emergency Medicine,
7435 W. Talcott Ave, Chicago, IL 60631. Email: jgordon@
presencehealth.org.
Conicts of Interest: By the WestJEM article submission agreement,
all authors are required to disclose all afliations, funding sources
and nancial or management relationships that could be perceived
as potential sources of bias. The authors disclosed none.
Copyright: © 2016 Gordon et al. This is an open access article
distributed in accordance with the terms of the Creative Commons
Attribution (CC BY 4.0) License. See: http://creativecommons.org/
licenses/by/4.0/
REFERENCES
1. Chang FC and Farha GJ. Inguinal Herniorrhaphy Under Local
Anesthesia. Arch Surg. 1977;112:1069-71.
2. Cassady JF. Regional Anesthesia for Urologic Procedures.
Urologic Clinics NA. 1987;14(1):43-50.
3. Earle AS. Local Anesthesia for Inguinal Herniorrhaphy. Am J Surg.
1960;100:782-6.
4. Kaye KW, Lange PH, Fraley EE. Spermatic Cord Block in Urologic
Surgery. J Urology. 1982;128(4):720-1.
5. Issa MM, Hsiao K, Bassel YS, et al. Spermatic Cord Anesthesia
Block for Scrotal Procedures in Outpatient Clinic Setting. J
Urology. 2004;172:2358-61.
6. Birkhauser FD, Wipi M, Eichenberger U, et al. Vasectomy
Reversal with Ultrasonography-guided Spermatic Cord Block. Br J
Uro Int. 2012;110:1796-1800.
7. Patil SG and Kamtikar SS. Treatment of Post-operative Orchialgia
with Therapeutic Unilateral Penile and Spermatic Cord Block. Ind
J Anesth. 2012;58(3):315-6.
8. Kiesling VJ, Schroeder DE, Pauljev P, et al. Spermatic Cord Block
and Manual Reduction: Primary treatment for Spermatic Cord
Torsion. J Urology. 1984;132(5):921-3.
9. Wipi M, Birkhauser F, Luyet C, et al. Ultrasound-guided
Spermatic Cord Block for Scrotal Surgery. Br J Anaes.
2011;106(2):255-9.
10. Fuchs GF. Cord Block Anesthesia for Scrotal Surgery. J Urology.
1982;128:718-9.
SC
AN
... It is considered more perfect, more cost-effective, as well as a safe and effective imaging tool. [5][6][7][8] Unfortunately, one of the major drawbacks of ultrasoundguided SCB (US-SCB) is a single-injection technique, leading to a short postoperative analgesia duration. To overcome this disadvantage, some adjuvants, including opioids, clonidine, dexamethasone, magnesium, ketamine and α2-adrenoceptors agonists, have been used to prolong the analgesia duration. ...
View
... The analgesia is performed with a selection or combination of lidocaine 1-2% and 0.25% bupivacaine, blocking fast voltage-gated Na-channels essential for neuronal transmission. 17 Lidocaine maintains a duration of action for 2 h and bupivacaine for 4-8 h. The blocks may be repeated every 3-4 weeks for a durable response if the patient is hesitant to proceed with surgical intervention. ...
Current trends and therapies in orchialgia management
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  • Jun 2021
The management of pain is a complex condition that will be encountered by most practicing clinicians. In the genitourinary community, testicular pain may be classified as acute or chronic. Initial evaluation of chronic groin and scrotal content pain (CGSCP) begins with a detailed history and physical examination to elucidate the presenting pathology. Multiple therapy algorithms have been proposed with no definitive consensus; however, most begin with conservative intervention and medical management prior to advancing to more invasive procedures. Surgical approaches may range from reconstruction, as in vasovasostomy for post-vasectomy pain syndrome, to excision of the offending agent, as in epididymectomy. This review seeks to focus on chronic pain in the genitourinary community and review techniques of pain management in the current intervention for orchialgia, as well as identify future methods of treatment.
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... No presente relato, foi executado a técnica a cega, que consistia na palpação manual e identificação do cordão espermático, prosseguindo com a inserção da agulha na região identificada para injetarmos o anestésico local, esse tipo de técnica possui algumas vantagens, tais como: redução do consumo de opioides e maior controle analgésico durante o trans cirúrgico, mas também pode possuir algumas desvantagens, principalmente o que diz a injeção de anestésico de forma intravascular, lesões vasculares e danos aos ductos deferentes. Essas desvantagens podem se tornar nulas, mediante uso de aparelho de ultrassonografia, para correta identificação do cordão espermático (Gordon & Rifenburg, 2016). No presente relato não houve nenhuma intercorrência. ...
Protocolo anestésico para Sapajus libidinosus (macaco prego) submetidos a vasectomia e laqueadura de trompas eletivas
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A captura, imobilização ou anestesia segura e efetiva de animais selvagens, como os macacos pregos (Sapajus libidinosus), geralmente é necessária para pesquisa e manejo, como também procedimentos cirúrgicos e diagnósticos, e dentre as espécies neotropicais, é a que apresenta maior distribuição geográfica. O gênero vem sendo utilizado em diversas pesquisas, dada a sua proximidade filogenética com a espécie humana, servindo de modelo biológico em experimentos aplicados a essa espécie. Há uma variedade de protocolos anestésicos utilizados para que a captura e o manuseio de macacos pregos seja realizada de modo simples e seguro. O objetivo deste trabalho é relatar a utilização da associação de dexmedetomidina, cetamina, morfina e midazolam para a contenção química de oito macacos-prego adultos, submetidos a dois procedimentos cirúrgicos, vasectomia nos machos e laqueadura das trompas eletivas nas femêas, tendo como meta estabelecer um protocolo de imobilização e contenção química segura e eficaz para a espécie. Durante os procedimentos cirúrgicos foram monitorados os parâmetros fisiológicos de frequência cardíaca, frequência respiratória, oximetria de pulso e temperatura retal de oito macacos prego. Ao término das cirurgias, os animais receberam atipamezole por via intramuscular. O protocolo utilizado demonstrou-se seguro e eficaz para contenção química de macacos-prego submetidos a procedimentos cirúrgicos distintos permitindo reversão dos efeitos farmacológicos ao término da cirurgia.
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... Esta traz como vantagens a diminuição no requerimento de opioides e maior controle da dor pós-operatória, porém como desvantagem pode ocorrer lesão vascular e/ou administração intravascular e danos aos ductos deferentes. Desvantagens que podem ser anuladas com o uso da ultrassonografia como método auxiliar na localização exata do cordão [10]. No presente caso, a administração pela técnica cega não causou qualquer complicação. ...
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Background: The black capuccin (Sapajus nigritus) is one of the most abundant primate specimens in Brazil. Among population control techniques, vasectomy can be used once it maintains the animal's leading behavior in the group through hormonal presence, production of spermatogenic series, and copula. However, due to their escape behavior, agitation, in addition to the impossibility of knowing the physiological state of these animals beforehand, their capture poses a considerable challenge. Thus, chemical restraint is indispensable and the use of effective and safe anesthetic protocols to animal integrity is of paramount importance. In this scenario, the present study aims to report the anesthesia of a black capuccin submitted to vasectomy.Case: A 1-year-old male, 1.1 kg monkey (Sapajus nigritus) was admitted at a Veterinary Hospital after being found on the ground in a natural reserve in the town of Assis Chateaubriand, in the west of Parana State. After clinical evaluation, the patient was submitted to vasectomy as a birth control method, before his return to the natural area, which presented overpopulation of the species. After preanesthetic examinations, the animal was considered healthy, and thus, premedicated with the combination of dexmedetomidine (10 μg/kg) and ketamine (10 mg/kg), intramuscularly. Anesthetic induction with propofol was performed to effect. Laringeal desensitization was achieved with 2% lidocaine (2 mg/kg), which allowed orotracheal intubation through direct visualization. Anesthesia was maintained with 1% isoflurane in a 0.5 oxygen fraction and spontaneous ventilation using a non-rebreathing circuit. The spermatic cord and the skin were desensitized with lidocaine (2 mg/kg). During the procedure, the animal was monitored for pulse oximetry, electrocardiogram, systolic blood pressure, body temperature, end tidal CO2 (ETCO2), and end tidal isoflurane. The animal also received 10 mL/kg/h ringer lactate throughout anesthesia and 30 mg/kg ampiciline as prophylactic antibiotic. After the completion of the surgery, inhalation anesthesia was interrupted and the animal was allowed to wake up. Discussion: The combination of 10 µg/kg dexmedetomidine and 10 mg/kg ketamine caused intense muscle relaxation and short-term sedation, which lasted 15 min. Protocol was sufficient for veno puncture and pre-oxygenation, but doses should be increased for longer procedures. Although other authors reported physiologic alterations with higher doses of these drugs, such complications were not observed in the present case. The anesthetic induction was smooth, with no excitement or complications. Propofol was infused at 1 mg/10 s, and a total dose of 10 mg/kg was necessary for induction. This rapid infusion rate could have caused the increase in propofol total dose, as described elsewhere. Propofol and local lidocaine allowed orotracheal intubation with a 2.5 mm uncuffed neonatal tube. During surgery, analgesia was achieved with pre surgical local anesthetic and a single bolus of fentanyl during duct deferens manipulation. During anesthesia, heart rate was maintained between 140 and 170 bpm; systolic blood pressure, between 85 and 110 mmHg; respiratory rate, between 30 and 50 mpm; and ETCO2, between 25 and 30 mmHg. No assistance in ventilation was necessary. The procedure lasted one hour, and extubation occurred seven minutes after the interruption of inhalational anesthetic. Anesthesia and anesthesia recovery occurred without complications, allowing the accomplishment of a short duration surgical procedure. After the post operatory period, the animal was reintroduced to the wild, with authorization of the state environmental agency. In conclusion, low dose dexmedetomidine combined with ketamine is adequate for rapid chemical restraint of black capuccin, and do not cause physiologic alterations during isoflurane anesthesia.
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... The spermatic cord can be readily palpated at this level after exiting the external inguinal ring, allowing for easy targeting of the injection. For patients with challenging anatomy secondary to obesity or prior surgery, ultrasound guidance is easily utilized to ensure good positioning of the block (36). After performing the block, the patient's response is assessed with a rating on the numerical pain scale, which is then compared to a pre-block value. ...
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Every practicing urologist encounters patients complaining of chronic scrotal content pain (CSCP). This condition can be equally frustrating for both patients and clinicians as there are no clear treatment guidelines, or pathways, for urologists to follow. As a result, most patients typically seek out multiple providers without improvements in their symptoms. Fortunately, microsurgical spermatic cord denervation (MSCD) is becoming an accepted, reliable and reproducible technique for definitively addressing CSCP in select patients. This manuscript reviews the background, effectiveness and current practice guidelines for scrotal pain in general, and MSCD in particular. Technical insights into how this technique can be performed both safely, and efficaciously, are provided. Finally, the manuscript presents a simple, yet detailed, easy to follow treatment algorithm to aid all urologists in the management of patients presenting with chronic pain.
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Introduction/Purpose Percutaneous core‐needle biopsy of the testicle has been shown to be a safe and effective method of obtaining tissue for histological analysis and can be considered in specific clinical scenarios. While the use of spermatic cord block has been shown to be effective in pain relief in the emergent setting and as an anaesthetic option for inguinal surgery, its use in percutaneous core‐needle biopsy has not been well described. Through this case series, we present our experience and technique of ultrasound‐guided percutaneous core‐needle biopsy using spermatic cord block in the setting of indeterminant testicular masses. Methods Our departmental biopsy database was reviewed to identify patients who underwent percutaneous core‐needle biopsy of the testicle from March 2010 to July 2022 and who also received spermatic cord block during the procedure. Results Three patients were identified who met the search criteria. All three patients presented for the evaluation of indeterminant testicular mass and had a known non‐testicular primary cancer diagnosis at the time of biopsy. All three biopsies were performed using a combination of spermatic cord block, moderate sedation, and local anaesthetic. Biopsies were obtained using an 18‐gauge spring‐loaded device with 4‐5 core samples obtained during each procedure. All biopsies were well tolerated without significant pain or post‐procedure complications. Discussion Ultrasound‐guided percutaneous core‐needle testicular biopsy using spermatic cord block is a safe and effective option in sampling indeterminate testicular masses while maintaining patient comfort. Conclusion The inclusion of a spermatic cord block in combination with local anaesthetic and moderate sedation has become standard practice in our institution, as we believe this maximises patient comfort and safety resulting in a better patient experience.
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Microsurgical Denervation of the Spermatic Cord: A Historical Perspective and Recent Developments
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Introduction The management of chronic scrotal pain is long and varied, with historical treatment algorithms typically ending with orchiectomy. Microsurgical denervation of the spermatic cord (MDSC) is a testicle-sparing option for patients who have failed conservative treatment options and over its forty-year history has seen many technical refinements. Objectives To review the history and development of MDSC and discuss the outcomes of different surgical techniques. Methods A literature review using PubMed and Google Scholar was conducted to identify studies pertaining to surgical treatment of CSP, MDSC, and outcomes. Search terms included “chronic,” “scrotal pain,” “orchialgia,” “spermatic cord,” “denervation,” and “microsurgery.” Results We included 21 case reports and series since the first seminal paper describing MDSC technique in 1978. Additional studies that challenged existing conventions or described novel techniques are also discussed. The current standard procedure utilizes a subinguinal incision and a surgical microscope. Open, robotic, and laparoscopic approaches to MDSC have been described, but access to minimally invasive instruments may be limited outside of developed nations. Pain reduction following preoperative spermatic cord predicts success of MDSC. Methods for identifying and preserving the testicular and deferential arteries vary depending on surgeon preference but appear to have comparable outcomes. Future developments in MDSC involve targeted denervation, minimizing collateral thermal injury, and alternative techniques to visualize arterial supply. Conclusion For patients suffering from CSP, MDSC is a well-studied technique that may offer appropriately selected patients’ relief. Future investigation comparing targeted vs full MDSC as well as in vivo study of new techniques are needed to continue to improve outcomes.
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Ultrasound-guided Spermatic Cord Block for Scrotal Surgery
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Full-text available
  • Nov 2010
  • BRIT J ANAESTH
Performing spermatic cord block for scrotal surgery avoids the potential risks of neuraxial and general anaesthesia and provides long-lasting postoperative analgesia. A blindly performed block is often inefficient and bears its own potential risks (intravascular injection of local anaesthetics, haematoma formation and perforation of the deferent duct). The use of ultrasound may help to overcome these disadvantages. The aim of this study was to test the feasibility and monitor the success rate of a new ultrasound-guided spermatic cord block. Twenty consecutive patients undergoing urologic surgery (subcapsular orchiectomy or vaso-vasostomy) were included in this prospective study. Using a linear ultrasound probe, the spermatic cord was identified by locating the spermatic artery and the deferent duct. A 23 G Microlance needle was advanced close to the deferent duct by avoiding vessel perforation, and local anaesthetic was deposited around the deferent duct under direct visualization. The primary outcome was the success rate of the block which was defined as surgery without any substitution of opioids, additional local anaesthetics, or sedatives. In 20 patients, 40 blocks were performed with a success rate of 95% (n=38). The failure rate was 5% (n=2) and no conversion to general anaesthesia was needed. The mean duration of the block was 14.1 h (sd 6.9). The use of ultrasound guidance to perform spermatic cord block is feasible and has a high success rate. Our new approach may become a suitable alternative to neuraxial or general anaesthesia especially in the ambulatory surgical setting.
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Inguinal Herniorrhaphy Under Local Anesthesia
Article
  • Sep 1977
  • ARCH SURG-CHICAGO
• For various reasons, repair of inguinal hernias under local anesthesia is not well accepted. The purpose of this study is to evaluate the effectiveness of local anesthesia in inguinal hernia repairs. One hundred consecutive inguinal herniorrhaphies are reported. The selection of patients, surgical technique, and incidence of intraoperative and postoperative complications are reported. Patient acceptance and their immediate postoperative course are also described. The study demonstrates that inguinal hernias can be easily repaired under local anesthesia, complications are minimal, and patient acceptance, excellent. We strongly recommend that this form of anesthesia be used in the "routine" repair of inguinal hernias in cooperative patients. (Arch Surg 112:1069-1071, 1977)
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Vasectomy reversal with ultrasonography-guided spermatic cord block
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Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Vasectomy reversal is often performed in general or neuraxial anaesthesia. Even though the site of vasectomy reversal is easily amenable to regional/local anaesthesia, spermatic cord blocks are rarely applied because of their risk of vascular damage within the spermatic cord. Recently, we described the technique of ultrasonography (US)-guided spermatic cord block for scrotal surgery, which, thanks to the US guidance, at the same time avoids the risk of vascular damage of blindly performed injections and the risks of general and neuraxial anaesthesia. Vasectomy reversal can easily be done in regional anaesthesia with the newly described technique of US-guided spermatic cord block without the risks of vascular damage by a blindly performed injection and the risks of standard general and neuraxial anaesthesia. In addition, this technique grants long-lasting postoperative pain relief and patients recover more quickly. Microsurgical conditions are excellent and patient satisfaction is high. Thanks to these advantages, more patients undergoing vasectomy reversal might avoid general or neuraxial anaesthesia.
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Spermatic cord anesthesia block (SCAB) for scrotal procedures in outpatient clinic setting
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  • Dec 2004
We evaluated the safety and effectiveness of spermatic cord anesthetic block (SCAB) as the only method of anesthesia for bilateral simple orchiectomy in an outpatient clinic setting. The study included 141 consecutive bilateral simple orchiectomy (BSO) procedures performed at Atlanta Veterans Affairs Medical Center during a 33-month period. All procedures were performed in an outpatient clinic setting using SCAB as the only method of anesthesia. The anesthetic solution consisted of an equal mixture of 1% lidocaine with epinephrine at 1:100,000 and 0.25% bupivacaine. A 10-point visual analog pain scale was used to assess pain/discomfort at baseline, during SCAB instillation and during BSO. Postoperatively overall patient impression/satisfaction with SCAB as a method of anesthesia was determined. Nine of the 141 available cases (6.4%) were excluded from study. The remaining 132 cases were included in data analysis. Mean patient age was 75.4 years (range 44 to 86). A total of 76 patients (57.6%) were receiving luteinizing hormone releasing hormone agonist therapy at the time of the procedure. The mean time needed to perform SCAB and BSO was 3.9 (range 2 to 6) and 33.0 minutes (range 12 to 70), respectively. The average volume of anesthetic solution was 20.1 ml per case (range 10 to 32). The mean pain score was 0.36 (range 0 to 8), 1.96 (range 0 to 8) and 0.33 (range 0 to 5) at baseline, and during SCAB and BSO, respectively. Of the patients 102 (77.3%) underwent a painless procedure (pain score = 0), 29 (21.9%) experienced transient pain that was mild in nature (pain score 4 or less) and only 1 (0.7%) had a pain score of 5. Pain scores were similar in patients who were and were not receiving luteinizing hormone releasing hormone agonists at baseline (p = 0.36), during SCAB instillation (p = 0.89) and during BSO (p = 0.36). The overall impression/satisfaction with SCAB as a method of anesthesia was rated as highly satisfactory by 91.7% of patients and satisfactory by 8.3%. There were no intraoperative adverse events related to SCAB. SCAB is a simple, safe and highly effective method of anesthesia for scrotal procedures. It allows such procedures to be performed in an outpatient clinic setting, offering convenience and the potential for cost savings.
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Inguinal herniorrhaphy under local anesthesia. A prospective study of 100 consecutive patients, with emphasis on perioperative morbidity and patient acceptance
Article
  • Oct 1977
  • ARCH SURG-CHICAGO
For various reasons, repair of inguinal hernias under local anesthesia is not well accepted. The purpose of this study is to evaluate the effectiveness of local anesthesia in inguinal hernia repairs. One hundred consecutive inguinal herniorrhaphies are reported. The selection of patients, surgical technique, and incidence of intraoperative and postoperative complications are reported. Patient acceptance and their immediate postoperative course are also described. The study demonstrates that inguinal hernias can be easily repaired under local anesthesia, complications are minimal, and patient acceptance, excellent. We strongly recommend thath this form of anesthesia be used in the "routine" repair of inguinal hernias in cooperative patients.
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Regional Anesthesia for Urologic Procedures
Article
  • Mar 1987
  • UROL CLIN N AM
Most urologic procedures can be performed under regional blockade anesthesia. These techniques present specific advantages, including the avoidance of the consequences of general anesthesia. The employment of regional anesthesia is a skill requiring knowledge of anatomy and of the desirable and undesirable actions of local anesthetic agents. Sedation of patients undergoing regional blockade offers specific advantages that may contribute to the patient's comfort and safety.
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Spermatic Cord Block and Manual Reduction: Primary Treatment for Spermatic Cord Torsion
Article
  • Dec 1984
A total of 16 consecutive cases of acute torsion of the spermatic cord less than 24 hours in duration are presented. All patients were diagnosed and treated initially by spermatic cord blockade and attempted manual detorsion. Of the 16 patients 15 underwent successful detorsion under local anesthesia. All patients underwent subsequent bilateral orchiopexy. Testicular salvage was 93 per cent in those patients who underwent successful detorsion by manipulation.
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Spermatic Cord Block in Urologic Surgery
Article
  • Nov 1982
Local anesthesia sufficient for vasovasostomy, hydrocelectomy, spermatocelectomy or orchiectomy for prostatic carcinoma can be obtained with 10 to 12 ml. 0.5 per cent bupivacaine hydrochloride injected through the spermatic cord approximately 1 cm. below and medial to the pubic tubercle. The overlying skin is infiltrated with the same anesthetic. Preoperative and intraoperative sedation rarely is needed. The post-anesthetic recovery time is short and the need for postoperative analgesia is reduced.
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