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Background and AimsWhile nerve blocks have been described in urologic surgery, they are typically used adjunctively or involve limited nerve targets. This case highlights a novel approach using a complete triple block—ilioinguinal/iliohypogastric (II/IH), genital branch of the genitofemoral (gGFN), and pudendal (PUD) nerves—as the sole anesthetic for scrotal surgery. It also demonstrates the use of ultrasound and hydrodissection to minimize local anesthetic volume while ensuring effective surgical anesthesia.MethodsA 63-year-old ASA I male underwent outpatient excision of a 3×3 cm spermatocoele under ultrasound-guided regional anesthesia alone. Blocks were performed with 0.5% ropivacaine: 12 mL (II/IH), 8 mL (gGFN), and 10 mL (PUD), using a seeker solution for hydrodissection. Sedation was limited to midazolam, fentanyl, and a light propofol TCI infusion. No airway instrumentation or additional analgesia was required.ResultsThe surgery proceeded uneventfully without signs of intraoperative pain or discomfort. Postoperatively, the patient remained stable, was discharged from PACU within an hour, and did not require rescue analgesia. No complications were noted on follow-up.ConclusionsThis is the first report demonstrating the feasibility of a triple nerve block technique (II/IH, gGFN, PUD) as the sole anesthetic for scrotal surgery. This approach enabled complete regional anesthesia, minimized opioid and sedative use, and facilitated same-day discharge. The use of ultrasound and hydrodissection further enhanced safety and efficiency, supporting its potential role in ambulatory urologic surgery.

Background and AimsGeneral anesthesia remains the standard for breast cancer surgery; however, regional nerve blocks present a viable alternative in select patients. This retrospective review reports a series of five Filipino female patients who underwent awake breast surgery using ultrasound-guided nerve blocks. It highlights the challenges of dosing local anesthetics in smaller-bodied individuals and explores effective block combinations for surgical anesthesia.MethodsPatient data from November 2024 to April 2025 were reviewed. All procedures were performed under sedation and ultrasound-guided nerve blocks. A multilevel thoracic paravertebral block was the main technique, combined with fascial plane blocks (interpectoral, pectoserratus, superficial serratus anterior, superficial parasternal) and intermediate cervical plexus blocks based on the surgical extent. Local anesthetic volumes and concentrations were adjusted per patient to stay within safe dosing limits.ResultsAll five patients underwent surgery without conversion to general anesthesia. No block-related complications were reported. Total ropivacaine doses ranged from 2.6 to 3.0 mg/kg. Postoperative analgesia was managed with non-opioid medications; none required rescue analgesia.ConclusionsAwake breast surgery using regional nerve blocks is feasible and effective in the Filipino population with appropriate dosing and block selection. This case series demonstrates promising outcomes and paves the way for a larger, prospective study to validate safety, efficacy, and reproducibility in a broader patient population.