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

Autor: Refugia JM; Department of Urology, Atrium Health Wake Forest Baptist Health, 140 Charlois Boulevard, Winston-Salem, NC, 27103, USA. jrefugia@wakehealth.edu., Thakker PU; Department of Urology, Atrium Health Wake Forest Baptist Health, 140 Charlois Boulevard, Winston-Salem, NC, 27103, USA., Roebuck E; Wake Forest School of Medicine, Winston-Salem, NC, USA., Brownstead HA; Department of Anesthesiology, Atrium Health Wake Forest Baptist Health, Winston-Salem, NC, USA., Rodriguez AR; Department of Urology, Atrium Health Wake Forest Baptist Health, 140 Charlois Boulevard, Winston-Salem, NC, 27103, USA., Tsivian M; Department of Urology, Atrium Health Wake Forest Baptist Health, 140 Charlois Boulevard, Winston-Salem, NC, 27103, USA.
Jazyk: angličtina
Zdroj: International urology and nephrology [Int Urol Nephrol] 2024 Jul; Vol. 56 (7), pp. 2227-2234. Date of Electronic Publication: 2024 Feb 06.
DOI: 10.1007/s11255-023-03939-w
Abstrakt: 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.
(© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)
Databáze: MEDLINE
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