Evaluating the Efficacy of Employing Local Anesthetic Prostatic Blocks During Rezum Procedure

Abstract

IntroductionRezum is a minimally invasive, outpatient procedure using convective water vapor to relieve outlet obstruction from benign prostatic hyperplasia (BPH). Evidence on the technical approach of Rezum therapy, particularly pain control, is lacking. The purpose of this study was to evaluate the efficacy of utilizing a local anesthetic prostate block for postoperative pain control during Rezum therapy for BPH. A multimodal approach is typically utilized for pain control during and after Rezum. However, little is known about which elements are most critical. MethodsThis is a single-center retrospective study of 109 patients who underwent Rezum for BPH. Patients were then divided into two groups: Local anesthetic prostatic block verse no local anesthetic prostatic block for the procedure. A phone survey was performed to assess the patients' subjective pain scores and postoperative analgesics usage. A comparison of reported pain scores on a 0-10 Likert scale as well as usage of prescription and non-prescription analgesics medications was performed. ResultsThere were 109 patients who underwent Rezum therapy, and 86 (79%) of patients responded to phone surveys. There was no significant difference in postoperative pain scores between patients who received local anesthetic prostatic block vs those who did not (2.10 vs 3.03). Similarly, there were no significant differences in postoperative narcotics or non-prescription analgesic medications usage. ConclusionOur data suggest that when performing Rezum using conscious sedation in the operating room or cystoscopy suite, it is unnecessary to perform a local anesthetic prostate block as it has no significant effect on patient-reported pain or the use of analgesics in the postoperative period.

The Efficacy of Rezum Water Vapor Therapy Among Malaysian Men with Lower Urinary Tract Symptoms Associated with Benign Prostatic Hyperplasia

“…Based on the small number of our patients being performed under local anaesthesia suggest that it is reasonable to perform this procedure under local anaesthesia. It has been reported in the previous study that Rezum therapy can be done under IV sedation without local anaesthetic prostatic block as it has no significant effect on patient-reported pain (20). The minimally invasive nature of this procedure coupled with its favourable safety profile makes it an attractive alternative for individuals seeking relief from BPH-related symptoms.…”

Anesthetic options for Rezūm water vapour therapy

“…Instead, we recommend utilizing minimal sedation for this minimally invasive procedure. Gilpin et al (2022) provided evidence that IV conscious sedation is tolerable for Rezūm and that an additional prostate block had no significant effect on patient-reported pain. 9 This is consistent with our study, as DIS patients did not receive any nerve blocks while patients in the OSLA cohort did.…”

“…Gilpin et al (2022) provided evidence that IV conscious sedation is tolerable for Rezūm and that an additional prostate block had no significant effect on patient-reported pain. 9 This is consistent with our study, as DIS patients did not receive any nerve blocks while patients in the OSLA cohort did. In a recent study by , the efficacy of a short-acting, minimal sedation method, methoxyflurane (Penthrox), was highlighted and shown to be a rapid, easily administered pain management strategy for Rezūm.…”

“…Patient preferences in periprocedural pain and anxiety management are significant factors in the selection of optimal sedation, which warrants a discussion between patients and their providers. 9 Another critical consideration for sedation selection is cost, given the higher costs of deep intravenous sedation compared to oral sedation. An added benefit of oral sedation is the decreased need for an anesthesiologist to be present compared to intravenous sedation, further reducing the costs associated with the procedure.…”

“…Reports of general anesthesia, spinal anesthesia, oral sedation, intravenous sedation and prostate block use existhowever, there is a gap in the literature regarding patient-reported outcomes and tolerability under varying anesthetic options. [7][8][9] While general and spinal anesthetics provide substantial periprocedural pain relief, they are associated with increased risks in frail patients with multiple comorbiditiesan increasingly common population in practice. 10 Conscious sedation provides a safe alternative for patient comfort and can alleviate anxiety during the procedure.…”