The Comparison of Periprostatic Nerve Blockage with the Combination of Perianally and Intrarectally Lidocaine Gel and Intrarectally Indomethacin Suppository in the Control of Pain Related to Transrectal Ultrasound Guided Prostate Biopsy Procedure
DOI:
https://doi.org/10.14205/2310-9394.2013.01.01.3Keywords:
Transrectal prostate biopsy, Periprostatic nerve blockage, Topical anesthetic gel, Pain, Visual analog scale.Abstract
Aims: In this study, we aimed to evaluate the effectiveness of the use of periprostatic nerve blockage with the combination of perianally and intrarectally lidocaine gel and intrarectally indomethacin suppository in the control of pain related to the TRUS-Bx procedure.
Materials and Methods: The data of 88 patients who underwent TRUS-Bx were retrospectively evaluated. The sample were divided in two groups according to the type of topical anesthesia previous to TRUS-Bx. In group 1 (n=42), while the combination of perianally and intrarectally lidocaine gel with intrarectally indomethacin suppository were applied to provide local anesthesia, a periprostatic nerve blockage by using 10 ml of %1 lidocaine solution were also performed in addition to this combination in group 2 (n=46). Ten point linear visual analog scale (VAS) was used to evaluate the pain. While VAS-1 score evaluated the pain that occured during TRUS probe placement and/or manipulations, VAS-2 score analysed the pain that occurred during the performation of needle biopsy.
Results: The mean ages, PSA values, and prostate volumes were similar between two groups (P= 0.437, P= 0.187, P= 0.194; respectively). The analysis of the pain related to TRUS probe placement and manipulation showed that VAS-1 score was found 2.72 ± 0.7 and 2.68 ± 08, respectively. The comparison of VAS-1 scores revealed that there was no statistically significant difference between two groups. Nevertheless, VAS-2 score, which evaluated the pain during the needle biopsy, was determined 5.36 ± 1.08 in group 1 and 2.13 ± 0.76 in group 2. It was found that VAS-2 score was significantly lower in group 2 (P= 0.001).
Conclusion: Our study revealed that periprostatic nerve blockage provided additional improvement in the control of pain related to only the step of needle biopsy in TRUS-Bx procedure.
References
Krishna Kumar R, Tandon R. Rheumatic fever & rheumatic heart disease: The last 50 years. Indian J Med Res 2013; 137: 643-58.
Allen U. Infective endocarditis: Updated guidelines. Can J Infect Dis Med Microbiol 2010; 21(2): 74-77.
Nesek-Adam V, Mrsic V, Smiljanic A, Oberhofer D, GrizeljStojcic E. Pathophysiologic effects of CO2- pneumoperitoneum in laparoscopic surgery. Acta Med Croatica 2007; 61(2): 165-70.
Choudhuri AH, Uppal R, Khaitan M. Laparoscopic cholecystectomy in a patient with Ebstein's anomaly: Anesthetic considerations. Saudi J Anaesth 2012; 6(3): 301- 302. http://dx.doi.org/10.4103/1658-354X.101229
Seitzinger MR, Dudgeon LS. Decreasing the degree of hypothermia during prolonged laparoscopic procedures. J Reprod Med1993; 38: 511-13.
Birch DW, Manouchehri N, Shi X, Hadi G, Karmali S. Heated CO(2) with or without humidification for minimally invasive abdominal surgery. Cochrane Database Syst Rev 2011; 19(1): CD007821.
Moore SS, Green CR, Wang FL, Pandit SK, Hurd WW. The role of irrigation in the development of hypothermia during laparoscopic surgery. Am J Obstet Gynecol 1997; 176(3): 598-602. http://dx.doi.org/10.1016/S0002-9378(97)70554-4
Bessell JR, Karatassas A, Patterson JR, Jamieson GG, Maddern GJ. Hypothermia induced by laparoscopic insufflation. Int J Nurs Stud 1995; 9(7): 791-96.
Morley AP, Derrick J, Seed PT, Tan PE, Chung DC, Short TG. Isoflurane dosage for equivalent intraoperative electroencephalographic suppression in patients with and without epidural blockade. Anesth Analg 2002; 95(5): 1412-8. http://dx.doi.org/10.1097/00000539-200211000-00057
Hodgson PS, Liu SS, Gras TW. Does epidural anesthesia have general anesthetic effects? A prospective, randomized, double-blind, placebo-controlled trial. Anesthesiology 1999; 91(6): 1687-92. http://dx.doi.org/10.1097/00000542-199912000-00021
Chakravarthy M, Jawali V, Patil T, Krishnamoorthy J. Decrease in pulmonary artery pressure after administration of thoracic epidural anesthesia in a patient with Marfan syndrome awaiting aortic valve replacement procedure. J Clin Monit Comput 2011; 25(4): 265-8. http://dx.doi.org/10.1007/s10877-011-9304-2
Groeben H. Epidural anesthesia and pulmonary function. J Anesth 2006; 20(4): 290-9. http://dx.doi.org/10.1007/s00540-006-0425-6
