Anesthetic considerations and postoperative pain management in radical penectomy: Case report

  • Juan Pablo Ghiringhelli M. a. Anesthesiology and Resuscitation Specialty, Medical School, Valparaíso Unversity. Valparaíso, Chile. b. Admiral Nef Naval Hospital. Viña del Mar, Chile.
  • Maryana López Medical School, Talca University. Talca, Chile.
Keywords: Radical penectomy, Penile cancer, Combined spinal-epidural anesthesia, Acute postoperative pain, Post surgical pain

Abstract

Radical penectomy (RP) is infrequently performed as it is reserved for specific cases of penile cancer, hence the paucity of reports regarding surgical and anesthetic considerations. Acute postoperative pain, chronic post-surgical pain, concomitant mood disorders as well as a profound impact on the patient’s quality of life have been documented. This case is of a patient with diabetes and coronary heart disease, who presented with advanced, overinfected penile cancer, depressive disorder and a history of pain of neuropathic characteristics. The patient underwent radical penectomy using a combined spinal-epidural technique for anesthesia. Preoperatively, the patient was treated with pregabalin and magnesium sulphate, and later received a blood transfusion due to intraoperative blood loss. Adequate intra and postoperative analgesia was achieved with L-bupivacaine given through a peridural catheter during one week. Recovery was good, pain was stabilized to preoperative levels and the patient received pharmacological support and follow-up by psychiatry and the pain team.

References

Neveu CR, Bórquez MP, Trujillo LC, Fernández R, Buchholtz FM. Experiencia de 10 años en el manejo del cáncer de pene, Instituto Nacional del Cáncer (1997-2006). Rev Chil Cir [Internet]. 2008;60(2):103-7. doi: http://dx.doi.org/10.4067/S0718-40262008000200004.

Moses KA, Winer A, Sfakianos JP, Poon SA, Kent M, Bernstein M, et al. Contemporary management of penile cancer: greater than 15 year MSKCC experience. Can J Urol. 2014;21(2):7201-6.

Sosnowski R, Kulpa, M, Kosowicz M, Wolski J, Kuczkiewicz O, Moskal K, et al. Quality of life in penile carcinoma patients-post-total penectomy. Cen European J Urol. 2016;69(2);204-11. doi: https://doi.org/10.5173/ceju.2016.828

Ghahhari J, Marchioni M, Spiess PE, Chipollini JJ, Nyirády P, Varga J. et al. Radical penectomy, a compromise for life: results from the PECAD study. Transl Androl Urol. 2020;9(3):1306-13. doi: https://doi.org/10.21037/tau.2020.04.04

Savu C, Surcel C, Mirvald C, Gîngu C, Hortopan M, Sinescu I. Atypical primary tuberculosis mimicking an advanced penile cancer. Can we rely on preoperative assessment? Rom J Morphol Embryol. 2012;53(4):1103-6. [citado 2020 ago 22]. Disponible en: https://rjme.ro/RJME/resources/files/53041211031106.pdf

Yadav K, Minhas R. Radical penectomy: procedure details of an uncommonly performed procedure for carcinoma penis and review of literature. Cancer Rep Rev. 2018;2. doi: https://doi.org/10.15761/CRR.1000149

Reinstatler L, Shee K, Gross MS. Pain management in penile prosthetic surgery: A review of the literature. Sex Med Rev. 2018;6(1):162-9. doi: https://doi.org/10.1016/j.sxmr.2017.05.005

Croll B, Voznesensky M. A case of phantom penile pain following penectomy. J Uro Neph Re Cas Rep. 2018;101. [citado 2020 ago 22]. Disponible en: http://www.scientizepublishers.com/wp-content/uploads/2020/03/2018-JUNRCR-101.pdf

Bouhassira D, Attal N, Alchaar H, Boureau F, Brochet B, Bruxelle J, et al. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new Neuropathic pain diagnostic questionnaire (DN4). Pain. 2005;114:29-36. doi: https://doi.org/10.1016/j.pain.2004.12.010

Maddineni SB, Lau MM, Sangar VK. Identifying the needs of penile cancer sufferers: a systematic review of the quality of life, psychosexual and psychosocial literature in penile cancer. BMC Urol. 2009;9:8. doi: https://doi.org/10.1186/1471-2490-9-8

Henry GD, Saccà A, Eisenhart E, Cleves MA, Kramer AC. Subarachnoid versus General Anesthesia in Penile Prosthetic Implantation: Outcomes Analyses. Adv Urol. 2012;2012:696752. doi: https://doi.org/10.1155/2012/696752

Shipton E. Post-surgical neuropathic pain. ANZ J Surg. 2008;78(7):548-5. doi: https://doi.org/10.1111/j.1445-2197.2008.04569.x

Jain P, Padole D, Bakshi S. Prevalence of acute neuropathic pain after cancer surgery: A prospective study. Indian J Anaesth. 2014;58(1):36-42. doi: https://doi.org/10.4103/0019-5049.126788

Laufenberg-Feldmann R, Kappis B, Mauff S, Schmidtmann I, Ferner M. Prevalence of pain 6 months after surgery: a prospective observational study. BMC Anesthesiol. 2016;16(1):91. doi: https://doi.org/10.1186/s12871-016-0261-7

Reddi D, Curran, N. Chronic pain after surgery: pathophysiology, risk factors and prevention. Postgrad Med J. 2014;90(1062):222-6. doi: https://doi.org/10.1136/postgradmedj-2013-132215

Andreae MH, Andreae DA. Regional anaesthesia to prevent chronic pain after surgery: a Cochrane systematic review and meta-analysis. Br J Anaesth. 2013;111(5):711-20. doi: https://doi.org/10.1093/bja/aet213

Nikolajsen L, Sørensen HC, Jensen TS, Kehlet H. Chronic pain following Caesarean section. Acta Anaesthesiol Scand. 2004;48(1):111-6. doi: https://doi.org/10.1111/j.1399-6576.2004.00271.x

Sessler DI, Neuraxial Anesthesia and Surgical Site Infection. Anesthesiology. 2010;113(2):265-7. doi: https://doi.org/10.1097/ALN.0b013e3181e2c1ed.

Urman RD, Boing EA, Pham AT, et al. Improved outcomes associated with the use of intravenous acetaminophen for management of acute post-surgical pain in cesarean sections and hysterectomies. J Clin Med Res. 2018;10(6):499-507. doi:10.14740/jocmr3380w doi: https://doi.org/10.14740/jocmr3380w

Montiel-Jarquín ÁJ, Contreras-Díaz AJ, Vázquez-Cruz E, Chopin-Gazga MA, Romero-Figueroa MS, Etchegaray-Morales I, et al. Análisis de supervivencia a cinco años en pacientes con cáncer de pene [Five-year survival analysis in patients with penile cancer]. Rev Med Inst Mex Seguro Soc. 2017;55(Suppl 1):S34-S43. Disponible en https://www.medigraphic.com/pdfs/imss/im-2017/ims171f.pdf

How to Cite
1.
Ghiringhelli M. JP, López M. Anesthetic considerations and postoperative pain management in radical penectomy: Case report. Colomb. J. Anesthesiol. [Internet]. 2021Feb.15 [cited 2021Jul.28];49(3). Available from: https://www.revcolanest.com.co/index.php/rca/article/view/964

Downloads

Download data is not yet available.
Published
2021-02-15
How to Cite
1.
Ghiringhelli M. JP, López M. Anesthetic considerations and postoperative pain management in radical penectomy: Case report. Colomb. J. Anesthesiol. [Internet]. 2021Feb.15 [cited 2021Jul.28];49(3). Available from: https://www.revcolanest.com.co/index.php/rca/article/view/964
Section
Case Report / Case Series