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. 2024 Jul;56(7):2227-2234.
doi: 10.1007/s11255-023-03939-w. Epub 2024 Feb 6.

Surgeon-administered regional nerve blocks during radical cystectomy: a feasibility study

Justin M Refugia  1 , Parth U Thakker  2 , Emily Roebuck  3 , Hilary A Brownstead  4 , Alejandro R Rodriguez  2 , Matvey Tsivian  2
Affiliations

Surgeon-administered regional nerve blocks during radical cystectomy: a feasibility study

Justin M Refugia et al. Int Urol Nephrol. 2024 Jul.

Abstract

Objective: To describe the technique for surgeon-administered, ultrasound-guided transversus abdominis plane (SU-TAP) blocks performed during radical cystectomy as a component of multimodal, perioperative pain management.

Methods: Retrospective, case series of patients receiving SU-TAP blocks just prior to incision for RC. TAP blocks were performed by the surgeon with a standard technique using US guidance to instill an anesthetic solution. The primary outcome was opioid consumption at the intervals of 0-12, 12-24, 24-36, and 36-48 h postoperatively. Opioid consumption was reported as oral morphine milligram equivalents (MME). Secondary outcomes included time to perform SU-TAP blocks, and safety of block procedure.

Results: 34 patients were included. During the median length of stay of 4 days (interquartile range [IQR] 3-7), only 30/34 (88%) of patients required opioids within the first 12 h post-op, decreasing to 38% by 48 h post-op. The median consumption decreased in the first 48 h from 21 MMEs (IQR 9-38) to 10 MMEs (IQR 8-15) at the 0-12 and 36-48 h intervals, respectively. The median time to perform block procedure was 6 min (IQR 4-8 min) and there were no safety events related to the SU-TAP blocks. Limitations include no comparative arm for opioid consumption.

Conclusion: Our data suggest that urologists may feasibly perform US-guided TAP blocks as a practical, efficient, and safe method of regional anesthesia. SU-TAP blocks should be considered in ERAS protocols for RC. Future comparative studies on opioid consumption compared to local infiltration and alternative block techniques are warranted.

Keywords: Bladder cancer; ERAS; Opioids; Radical cystectomy.

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