Surgeon-administered ultrasound-guided transversus abdominis plane blocks during radical cystectomy: description of technique and perioperative opioid requirement

You have accessJournal of UrologyCME1 Apr 2023MP32-07 SURGEON-ADMINISTERED ULTRASOUND-GUIDED TRANSVERSUS ABDOMINIS PLANE BLOCKS DURING RADICAL CYSTECTOMY: DESCRIPTION OF TECHNIQUE AND PERIOPERATIVE OPIOID REQUIREMENT Justin Refugia, Hilary Brownstead, Parth Thakker, Randy Casals, Corey Able, Emily Roebuck, and Matvey Tsivian Justin RefugiaJustin Refugia More articles by this author , Hilary BrownsteadHilary Brownstead More articles by this author , Parth ThakkerParth Thakker More articles by this author , Randy CasalsRandy Casals More articles by this author , Corey AbleCorey Able More articles by this author , Emily RoebuckEmily Roebuck More articles by this author , and Matvey TsivianMatvey Tsivian More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003265.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Implementation of standardized analgesic regimens is paramount to developing enhanced recovery after surgery (ERAS) protocols for radical cystectomy (RC). Transversus abdominis plane (TAP) blocks have demonstrated decreased length of stay (LOS) and perioperative opioid requirement. To date, no studies have reported on ultrasound (US) guided blocks performed by the surgeon in this setting. In this study, we present our technique for surgeon-administered, US-guided TAP (sUTAP) blocks and review postoperative opioid requirements. METHODS: We retrospectively reviewed patients that received sUTAP blocks just prior to incision for RC. The blocks were performed with US-guidance to advance the needle into the transversus abdominis plane at the anterior axillary line between the subcostal margin and iliac crest. Next, 25-cc of an anesthetic solution was instilled into this plane and the procedure was repeated on contralateral side (total of two injection sites). The primary objective was overall perioperative opioid requirement. Due to protocol changes, we also compared two groups of patients that received a 50-cc mixture of: 0.25% bupivacaine mixed with liposomal-bupivacaine (LB) or 0.25% bupivacaine only. Analyses were performed on demographics, surgical and anesthetic details, and perioperative medications. RESULTS: Between 2020 and 2022, we identified 47 patients that received sUTAP blocks during RC. The men (79%) had a median age of 70 years (IQR 61-75), and women (21%) had a median age 77 years (IQR 67-80). RC approach was open (81%) or robotic (19%). Urinary diversion was with ileal conduit (53%) or cutaneous ureterostomy (47%). Overall median perioperative MMEs: intraoperative – 85 (53-107), POD0 – 25 (15-45), POD1 – 15 (0-40), POD2 – 7.5 (0-25), POD3 – 2.5 (0-16), and POD4 – 0 (0-11). The overall median length of stay was 4 days (IQR 3-6). LB was included for 14 patients (30%) and intraoperative/POD1 MMEs were higher than the 33 patients (70%) that received bupivacaine only (p<0.05). CONCLUSIONS: Our results suggest that addition of sUTAP blocks may reduce postoperative opioid requirements. Learning our technique should be considered by surgeons that are developing ERAS protocols for RC. Further comparative studies between anesthesia-administered TAP blocks and other peri-operative regional pain management modalities may clarify efficacy of sUTAP. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e442 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Justin Refugia More articles by this author Hilary Brownstead More articles by this author Parth Thakker More articles by this author Randy Casals More articles by this author Corey Able More articles by this author Emily Roebuck More articles by this author Matvey Tsivian More articles by this author Expand All Advertisement PDF downloadLoading ...