Journal Article

P252 Excision of a spermatocoele under regional block as a sole anesthetic: a technical review

Tanada Isabella, Braganza, Samantha Claire

2025

Overview

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.

• Publisher: BMJ Publishing Group LTD
• Subject: Regional anesthesia / Ultrasonic imaging / Urological surgery