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

Abstract

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