Acupuncture assisted regional anesthesia for penile surgeries

Geng-Long Hsu, Cheng-Hsing Hsieh, Sheng-Jean Huang

Abstract

Although the mechanism of acupuncture for analgesia is not fully elucidated, a combination of acupuncture and several methods of topical blocks for local anesthesia has been effective to patients with indications for penile surgeries on ambulatory basis. We sought to review this unique clinical application since 1998 to summarize practice-based medical literature contingent this unique application and, in contrast, the commonly agreed either general or spinal anesthesia concerning those surgeries on this most sensitive organ-the delicate penis. From July 1998 to July 2013, 1,481 males underwent penile surgeries with specific topical nerve blockage in addition to acupuncture, in which the acupoints of Hegu (LI4), Shou San Li (LI10), Quchi (LI11) , and either Waiguan (TE5) or Neiguan (PC6) were routinely used. Careful anesthetic block of the paired dorsal nerve in the penile hilum associated with a peripenile infiltration was taken as method I, through which it is sufficient to anesthetize the penile structures for varied penile surgeries, including 993 penile venous stripping surgeries, 336 penile corporoplasties, 8 urethroplasties, 7 vaso-vasostomies, 6 penile arterial reconstruction cases and 3 penectomies. In method II, the bilateral cavernous nerve block and crural blockage were indispensably performed for anesthetizing the sinusoids of the corpora cavernosa (CC) for penile implant of varied model in 125 males. A further topical injection of the medial low abdominal region made it possible for implanting a three-piece model in three males. Thus recent discoveries and better understanding of the penile anatomy had been meaningful in the development and improvement of specific nerve blockade techniques for penile surgeries in particularly adding up with acupuncture techniques, while minimizing anesthetic adverse effects and resulting in a rapid return to daily activity with minimal complications.