Ultrasound guided rectus sheath and transverse abdominis blocks for robotic urological surgeries – A case series

Background: Robotic surgeries have improved perioperative outcomes. We have combined ultrasound (USG) guided bilateral rectus sheath (RS) block along with transverse abdominis plane (TAP) block to assess perioperative opioid requirement, visual analog scale (VAS) score, and modified Post Anesthetic Discharge Scoring System (PADSS) criteria for robotic urological surgeries. Ultrasound (USG)-guided blocks were given bilaterally after induction of general anesthesia. Methods: A total of ten patients scheduled for robotic urological surgeries were administered 30 ml of 0.25% bupivacaine (2.5 mg kg-1) with 0.75 mcg kg-1 of clonidine (10 ml of drug was given for TAP block and 5 ml of drug for RS block on each side) after negative aspiration. Results: Supplemental opioid was not required perioperatively, and 9 out of 10 patients were pain free (VAS score <3) for at least 6 h. Ten patients had a modified PADSS score ≥10 after 6 h of surgery. Conclusion: USG combined TAP and RS blocks is a promising technique with low learning curve, excellent analgesia, reduced opioid consumption, and higher PADSS score in the perioperative period.