Selective Low-Dose Spinal Anesthesia for Transrectal Prostate Biopsy: A Prospective and Randomized Study

Kucur, Mustafa; Göktaş, Serdar; Kaynar, Mehmet; Apilioğulları, Seza; Kılıç, Özcan; Akand, Murat; Gül, Murat; Çelik, Jale Bengi

doi:10.1089/end.2015.0450

Cited by 12 publications

(12 citation statements)

References 28 publications

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“…They achieved higher patient's satisfaction with no motor blockade and no more complication in spinal anesthesia than PPNB group. [ 24 ] In the current study, similarly, we also used low-dose spinal anesthesia (1.5 mg bupivacaine) and observed lower VAS score in compare with other anesthetic methods. There were no motor blockade or hemostatic instability and on more major complication than other methods.…”

Section: Discussionmentioning

confidence: 51%

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

et al. 2018

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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.

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Section: Discussionmentioning

confidence: 51%

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

et al. 2018

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“…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.…”

Section: Discussionmentioning

confidence: 76%

“…Next, a review of full-text articles was performed to evaluate whether they met the inclusion criteria. A total of 47 RCTs 1–5,9–50 with a total of 5,758 patients were finally included in this study. The characteristics of included studies are displayed in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…The introduction of transrectal ultrasonography (TRUS)-guided prostate biopsy (PBx) in 1989 was a significant development in diagnostic methodology for detection of prostate cancer (PCa). This new method quickly became the gold standard for the detection of PCa and remains the method of choice to the present day 1 . Although many patients can tolerate PBx the procedure can cause severe pain 2 .…”

Section: Introductionmentioning

confidence: 99%

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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

Kim

Lee

Jung

et al. 2019

Sci Rep

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We aimed to compare the effectiveness of various local anesthetic methods for controlling prostate biopsy (PBx) related pain using network meta-analysis. Literature searches were performed on PubMed/Medline, Embase, and Cochrane Library up to March 2018. Forty-seven randomized controlled trials, in which the effectiveness of PBx-related pain was investigated using a visual analogue scale after various local anesthetic methods, were included. The local anesthetic methods included intraprostatic local anesthesia (IPLA), intrarectal local anesthesia (IRLA), intravenous sedation (IVS), periprostatic nerve block (PNB), pelvic plexus block (PPB), and spinal anesthesia (SPA). Eight pairwise meta-analyses and network meta-analyses with 21 comparisons were performed. All modalities, except single use of IPLA and IRLA, were more effective than placebo. Our results demonstrate that PNB + IVS (rank 1) and SPA (rank 2) were the most effective methods for pain control. The followings are in order of PPB + IRLA, PNB + IPLA, PPB, PNB + IRLA, IVS, and PNB. In conclusion, the most effective way to alleviate PBx-related pain appears to be PNB + IVS and SPA. However, a potential increase in medical cost and additional risk of morbidities should be considered. In the current outpatient setting, PPB + IRLA, PNB + IPLA, PPB, PNB + IRLA, and PNB methods are potentially more acceptable options.

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“…Although PNB technique introduced by Nash et al . in 1996 is regarded as the standard method of overcoming the pain during prostate biopsy, several other analgesic techniques have been investigated, which include the IRLA; perianal local anesthetic injection; various analgesics, such as oral non‐steroidal anti‐inflammatory agents and opioids; an application of an inhaled mixture of nitrous oxide and oxygen; selective low‐dose spinal anesthesia and PPNB . Although all these techniques provide better pain control alone when compared with placebo, none of them is better than PNB.…”

Section: Discussionmentioning

confidence: 99%

Periprostatic nerve block alone versus combined with perineal pudendal nerve block or intrarectal local anesthesia during transrectal ultrasound‐guided prostate biopsy: A prospective randomized controlled trial

et al. 2019

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Objectives To compare the efficacy, safety and cost of combinations of perineal pudendal nerve block + periprostatic nerve block and intrarectal local anesthesia + periprostatic nerve block with the standard technique (periprostatic nerve block). Methods The study was designed as a randomized prospective controlled trial. Patients with elevated serum prostate‐specific antigen values (prostate‐specific antigen ≥4 ng/mL) and/or abnormal digital rectal examination findings were included in the study. Patients with anorectal diseases, chronic prostatitis, previous history of prostate biopsy and anorectal surgery were excluded from the study. A total of 148 patients (group 1 [periprostatic nerve block], n = 48; group 2 [intrarectal local anesthesia + periprostatic nerve block], n = 51; group 3 [perineal pudendal nerve block + periprostatic nerve block], n = 49) were included in the final analysis. Pain during insertion and manipulation of the transrectal ultrasound probe was recorded as visual analog scale 1, pain during penetration of the biopsy needle into the prostate and sampling was recorded as visual analog scale 2, and pain during the entire procedure recorded as visual analog scale 3. Results The mean visual analog scale 1 score was significantly lower in group 3, when compared with group 1 and group 2 (P < 0.001). There was no significant difference between the groups in terms of the mean visual analog scale 2 score. The mean visual analog scale 3 score was significantly lower in group 3 when compared with other groups (P < 0.001). The total cost for transrectal ultrasound‐guided biopsy in the intrarectal local anesthesia + periprostatic nerve block group was significantly higher than the other two groups. Conclusions The combination of perineal pudendal nerve block and periprostatic nerve block provides more effective pain control than intrarectal local anesthesia plus periprostatic nerve block and periprostatic nerve block alone, with similar complication rates and without increasing cost.

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Selective Low-Dose Spinal Anesthesia for Transrectal Prostate Biopsy: A Prospective and Randomized Study

Cited by 12 publications

References 28 publications

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

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

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

Periprostatic nerve block alone versus combined with perineal pudendal nerve block or intrarectal local anesthesia during transrectal ultrasound‐guided prostate biopsy: A prospective randomized controlled trial

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