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

• Published in: Journal of research in medical sciences Vol. 23; no. 1; p. 17
• Main Authors: Mazdak, Hamid, Abtahi, Amir, Momeni, Fatemeh, Izadpanahi, Mohammad
• Format: Journal Article
• Language: English
• Published: India Wolters Kluwer India Pvt. Ltd 01.01.2018; Medknow Publications and Media Pvt. Ltd; Medknow Publications & Media Pvt. Ltd; Medknow Publications & Media Pvt Ltd; Wolters Kluwer Medknow Publications
• Subjects: Analgesics; Analysis; Anesthesia; Biopsy; Clinical trials; Comparative analysis; Complications and side effects; Dosage and administration; Intravenous sedation; Methods; nerve block; Original; Pain; Pain management; Patients; Prostate biopsy; Prostate cancer; Sample size; spinal anesthesia; Studies; trans rectal ultrasonography; Ultrasonic imaging; Intravenous sedation; prostate biopsy; pain; spinal anesthesia; trans rectal ultrasonography; nerve block
• ISSN: 1735-1995; 1735-1995; 1735-7136
• DOI: 10.4103/jrms.JRMS_639_17

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.