A comparison of pain control and complications using three different ways of anesthesia in patients undergoing transrectal ultrasound-guided prostate biopsy

Abstract

Background:We aim to compare the degree of pain control and complications in three types of anesthesia using periprostatic nerve block (PPNB) plus intrarectal local anesthesia (IRLA), low-dose spinal anesthesia, and intravenous (IV) sedation in patients undergoing transrectal ultrasound (TRUS)-guided prostate biopsy.Materials and Methods:In this clinical trial study, 106 patients were participated from December 2015 to December 2016 at Alzahra Hospital, Isfahan, Iran. Patients were randomly allocated into three groups to receive PPNB plus IRLA (n = 36), low-dose spinal anesthesia (n = 35) and IV sedation (n = 35) before TRUS-guided prostate biopsy. Pain scores were recorded using a 10 point visual analog scale right after the biopsy was done. Early and late complications were assessed using a questionnaire after the procedure and in follow-up of patients.Results:Overall, the pain score in the low-dose spinal anesthesia group was significantly lower than PPNB plus IRLA and IV sedation groups (P < 0.001). The differences in pain scores between PPNB plus IRLA group and IV sedation group were not significant (P = 0.30). Urinary retraction and fever were significantly more frequent in low-dose spinal anesthesia and IV sedation, retrospectively (P = 0.04, P = 0.03). No significant difference in late complications was found among the groups.Conclusion:This study demonstrates that low-dose spinal anesthesia is superior to PPNB plus IRLA and IV sedation in terms of pain controlling and was associated with higher tolerance of the examination and patient comfort.

What is the most effective local anesthesia for transrectal ultrasonography-guided biopsy of the prostate? A systematic review and network meta-analysis of 47 randomized clinical trials

“…Other trials used SPA with a low dose of 0.5% bupivacaine (0.5–1.5 mL) at the L3-5 level. They reported SPA significantly decreases pain during the procedure 1 , 31 , 34 , 46 . Moreover, there was no significant difference in anesthesia time or pain due to anesthesia itself compared with PNB.…”

“…Three recent trials investigated the effect of IVS for pain control during PBx 14 , 31 , 50 . Atta et al .…”

“…Mazdak et al . 31 performed IVS by infiltration of midazolam (25 μg/kg), fentanyl (2 μg/kg), and ketamine (1 mg/kg) through an antecubital vein at 5 min before taking the biopsies. They reported that the differences in VAS score between PNB + IRLA and IVS are not statistically significant.…”

“…SPA is an ideal anesthetic for anorectal surgery 1 and had a highly probability of being ranked second in our study. Four of the included trials investigated the PBx pain control effect of SPA 1 , 31 , 34 , 46 . We classified the caudal block in one trial 46 into one kind of SPA in which caudal block was accomplished using 20 mL of 1.2% lidocaine.…”