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

BACKGROUND AND PURPOSE  - To evaluate the use of spinal anesthesia by reducing anesthetic agent dose to provide better analgesia with minimal side effects without sacrificing the outpatient setting for prostate biopsy. In this study, efficacy and tolerability of selective low dose spinal anesthesia versus intrarectal local anesthesia (IRLA) plus periprostatic nerve blockade (PPNB) were compared.

METHODS - Between September 2012 and April 2013 100 patients, aged 40 - 80, prostate specific antigen (PSA) ≥4ng/ml, abnormal digital rectal examinations, and enrolled for biopsy were included in the present study. Ensuring double blindness, pain was assessed using visual analog scale (VAS). Anal sphincter relaxation, patients' satisfaction with the anesthesia technique, and motor response were evaluated.

RESULTS - Differences between the two groups, considering age, ASA score, tPSA, prostate volume, anesthesia duration, and cancer presence, were not statistically significant. Pain experienced during probe insertion, biopsy, and 30 minutes after biopsy was significantly lower in low dose spinal anesthesia group (p<0.0001). Anal sphincter relaxation degree was significantly higher in spinal group (p<0.001). Patients procedure related overall satisfaction level was significantly higher in the spinal anesthesia group (p<0.001). In the spinal anesthesia group no motor blockade was observed. Between the two groups no statistically significant difference was seen with regard to complications (p>0.05).

CONCLUSION -  Selective low dose spinal anesthesia provides better pain relief than PPNB plus IRLA without sacrificing the day case setting in ambulatory practice. It is also associated with high patient satisfaction and willingness for a repeat biopsy without differences in procedure duration, tolerance, and complications.

J Endourol. 2015 Jul 15. [Epub ahead of print]

Kucur M1, Göktaş S2, Kaynar M3, Apiliogullari S4, Kilic O5, Akand M6, Gul M7, Celik J8.

1 Batman State Hospital, Urology, Batman, Turkey
2 Selcuk University, Faculty of Medicine, Urology, Konya, Turkey
3 Selcuk University, Faculty of Medicine, Urology, Konya, Turkey
4 Selcuk University, Faculty of Medicine, Anesthesia and Intensive Care, Konya, Turkey
5 Selcuk University, Faculty of Medicine, Urology, Konya, Turkey
6 Selcuk University, School of Medical, Urology , Selcuk Universitesi, Alaaddin Keykubat Kampusu , Tip Fakultesi Hastanesi, E-Blok, Kat:1 , Uroloji Poliklinigi, Selcuklu , Konya, Turkey
7 Van Education and Research Hospital, Urology, Van, Turkey
8 Selcuk University, Faculty of Medicine, Anesthesia and Intensive Care, Konya, Turkey