Introduction: 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.
