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Please confirm that an ethics committee approval has been applied for or granted: Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submission Application for ESRA Abstract Prizes: I apply as an Anesthesiologist (Aged 35 years old or less)Background and AimsBackground: Percutaneous nephrolithotomy and placement of nephrostomy tube is performed for renal stones > 2 cm in diameter. Attempts have been made to infiltrate local anaesthetics with or without adjuvants into the surgical site to reduce pain. We hypothesized that there would be a significant prolongation of the analgesic effect of local anaesthetic instillation along nephrostomy tube due to the adjuvant dexamethasone. Aims/Objectives: We compared the duration of analgesia in terms of the maximum numeric rating scale at 2,4,6,12,24, 48 and 60 hours postoperatively between Ropivacaine (R) and Ropivacaine-dexamethasone (R+D) groups. The total cumulative dose of Ropivacaine and Dexamethasone and the rescue analgesic fentanyl along with ESR and CRP were also determined.MethodsAfter ethical approval and CTRI registration (CTRI/2020/03/024332), 64 ASA I&II adult patients were enrolled in this randomized double blinded prospective study divided into Group R – received 20 ml 0.2% Ropivacaine and Group R+D – received 20 ml 0.2% Ropivacaine with dexamethasone 8 mg, injected through a multi-lumen wound infiltration catheter.ResultsThe demographic profile of patients was similar in both the groups. The mean duration of analgesia was longer in Group R+D (21.3 +/- 2.1 hrs) vs Group R (10+/-1.9 hrs, p = 0.001). The mean NRS scores of Group R+D were significantly lower at all time intervals (p = 0.001). Also, the cumulative dose of ropivacaine and the total use of fentanyl postoperatively in group R was much higher (70+/-10.4 vs 56+/- 8.9 mcg, p = 0.02). The CRP levels were significantly lower in Group R+D (13.8 +/- 1.5 vs 23.1 +/- 1.2 mg/L, p=0.001 and 16.5 +/- 1.3 vs 28.5 +/- 1.7 mg/L, p=0.001, at 24 and 48 hours respectively).ConclusionsWe conclude that dexamethasone can be used as a suitable adjuvant to intermittent local anaesthetic infiltration after PCNL with nephrostomy tube for the prolongation of analgesia.

Purpose of ReviewAmid the opioid crisis, postoperative pain management is a major challenge for practitioners. Recent pain management guidelines emphasize the importance of using regional anesthesia as part of opioid-sparing multimodal analgesia. This report aims to review recent evidence regarding the utilization of transversus abdominis plane (TAP) block in minimally invasive urologic surgery.Recent FindingsTAP block has been shown to improve early and late pain at rest, and to reduce opioid consumption after minimally invasive surgery. These benefits have indirectly reduced the incidence of postoperative delirium, pneumonia, urinary retention, and falls. Compared to epidural analgesia, TAP block provides similar pain control, has a lower incidence of hypotension, and is associated with a shorter length of stay.SummaryFew studies focus specifically on the outcomes of TAP block in minimally invasive urologic surgery. TAP block decreases postoperative pain and reduces opioid consumption without increasing complications. TAP block should be integrated as an indispensable component in enhanced recovery after surgery protocols.

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.

Adjuvant pembrolizumab improved disease-free survival in patients with high-risk urothelial cancer.

After cystectomy, patients with muscle-invasive bladder cancer were randomly assigned to pembrolizumab or observation for 1 year. The pembrolizumab group had a median disease-free survival twice as long as the observation group.