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Comparison of Pudendal Nerve Blockade, Tenoxicam Suppository and Rectal Lidocaine Gel Anesthesia for Transrectal Ultrasound-Guided Biopsy of the Prostate

Year 2009, Volume: 16 Issue: 3, 141 - 144, 01.06.2009

Abstract

Aim: We assessed the safety and efficacy of three different local anesthesia methods (pudendal nerve blockade, tenoxicam suppository and rectal lidocaine gel) before transrectal ultrasound (TRUS)-guided biopsy of the prostate in this study. Materials and Methods: In our prospective and controlled study, 136 consecutive patients were randomized into four groups: men in group 1 (n=41) received no anesthesia, group 2 (n=30) received intrarectal 10 cc 2% lidocaine gel 10 mins before biopsy, group 3 (n=31) received 20 mg tenoxicam suppository 30 mins before biopsy and pudendal nerve blockade was performed in group 4 (n=34) 10 mins before biopsy using 10 ml of 1% lidocaine. The patients were asked to grade the pain when TRUS probe was inserted and during the biopsy procedure using a 11-point linear visual analog scale (VAS) and their pain scores were noted. Results: There were statistically significant differences among four groups regarding the mean VAS scores during probe insertion (p=0.024) and biopsy (p=0.012). This significance was provided by the difference between the group 1 and 4 (p=0.015 for probe insertion and p=0.022 for biopsy with Tukey test). No statistically significant difference was found among the pain scores of group 1, 2 and, 3 during probe insertion and biopsy. Conclusions: Pudendal nerve blockade was effective in reducing pain both during the biopsy procedure and probe insertion, while suppository tenoxicam and rectal lidocaine gel had no significant anesthetic effect. Key words: Prostate Biopsy, Anesthesia, Pain, Pudendal Nerve Blockade, Tenoxicam Suppository

References

  • Crundwell MC, Cooke PW, Wallace DM. Patients' tolerance of transrectal ultrasound-guided prostatic biopsy: an audit of 104 cases: BJU Int 1999; 83: 792–5.
  • Obek C, Ozkan B, Tunc B, Can G, Yalcin V, Solok V. Comparison of 3 different methods of anesthesia before transrectal prostate biopsy: a prospective randomized trial. J Urol 2004; 172: 502–5.
  • Issa MM, Bux S, Chun T, Petros JA, Labadia AJ, Anastasia K, Miller LE, Marshall FF. A randomized prospective trial of intrarectal lidocaine for pain control during transrectal prostate biopsy: the Emory University experience. J Urol 2000; 164: 397– 9.
  • Adsan O, Inal G, Ozdoğan L, Kaygisiz O, Uğurlu O, Cetinkaya M. Unilateral pudendal nerve blockade for relief of all pain during transrectal ultrasound-guided biopsy of the prostate: a randomized, double-blind, placebo-controlled study. Urology 2004; 64: 528–31.
  • Haq A, Patel HR, Habib MR, Donaldson PJ, Parry JR. Diclofenac suppository analgesia for transrectal ultrasound guided biopsies of the prostate: a double-blind, randomized controlled trial. J Urol 2004; 171: 1489–91.
  • Olkkola KT, Brunetto AV, Mattila MJ. Pharmacokinetics of oxicam nonsteroidal anti-inflammatory agents. Clin Pharmacokinet 1994; 26: 107–20.
  • Inal G, Yazici S, Adsan O, Ozturk B, Kosan M, Cetinkaya M. Effect of periprostatic nerve blockade before transrectal ultrasound-guided prostate biopsy on patient comfort: a randomized placebo controlled study. Int J Urol 2004; 11: 148– 51.
  • Irani J, Fournier F, Bon D, Gremmo E, Doré B, Aubert J. Patient tolerance of transrectal ultrasound-guided biopsy of the prostate. Br J Urol 1997; 79: 608–10.
  • Autorino R, De Sio M, Di Lorenzo G, Damiano R, Perdonà S, Cindolo L, D'Armiento M. How to decrease pain during transrectal ultrasound guided prostate biopsy: a look at the literature. J Urol 2005; 174: 2091–7.
  • Davis M, Sofer M, Kim SS, Soloway MS. The procedure of transrectal ultrasound guided biopsy of the prostate: a survey of patient preparation and biopsy technique. J Urol 2002; 167: 566– 70.
  • Cevik I, Ozveri H, Dillioglugil O, Akdaş A. Lack of effect of intrarectal lidocaine for pain control during transrectal prostate biopsy: a randomized prospective study. Eur Urol 2002; 42: 217– 20.
  • Chang SS, Alberts G, Wells N, Smith JA Jr, Cookson MS. Intrarectal lidocaine during transrectal prostate biopsy: results of a prospective double-blind randomized trial. J Urol 2001; 166: 2178–80.
  • Schraffordt SE, Tjandra JJ, Eizenberg N, Dwyer PL. Anatomy of the pudendal nerve and its terminal branches: a cadaver study. ANZ J Surg 2004; 74: 23–6.
  • Gabrielli F, Cioffi U, Chiarelli M, Guttadauro A, De Simone M. Hemorrhoidectomy with posterior perineal block: experience with 400 cases. Dis Colon Rectum 2000; 43: 809–12.
  • Dos Reis JM, Glina S, Da Silva MF, Furlan V. Penile prosthesis surgery with the patient under local regional anesthesia. J Urol 1993; 150: 1179–81.
  • Rossier AB, Fam BA, Lee IY, Sarkarati M, Evans DA. Role of striated and smooth muscle components in the urethral pressure profile in traumatic neurogenic bladders: a neuropharmacological and urodynamic study. Preliminary report. J Urol 1982; 128: 529– 35.
  • McDonald JS, Spigos DG. Computed tomography-guided pudendal block for treatment of pelvic pain due to pudendal neuropathy. Obstet Gynecol 2000; 95: 306–9.
  • Kovacs P, Gruber H, Piegger J, Bodner G. New, simple, ultrasound-guided infiltration of the pudendal nerve: ultrasonographic technique. Dis Colon Rectum 2001; 44: 1381–5.
  • Choi SS, Lee PB, Kim YC, Kim HJ, Lee SC. C-arm-guided pudendal nerve block: a new technique. Int J Clin Pract 2006; 60: 553–6.
  • Shafik A, el-Sherif M, Youssef A, Olfat ES. Surgical anatomy of the pudendal nerve and its clinical implications. Clin Anat 1995; 8: 110–5.
  • Corresponding Author: Cüneyt ÖZDEN, MD
  • Cevizlidere Mah. 14. Cad. 12/25 06520 Balgat/ANKARA Tel: 05052729744
  • E -mail: cuneytozden@hotmail.com

Transrektal Ultrasonografi Kılavuzluğunda Prostat Biyopsisi İçin Pudental Sinir Bloğu, Supozituar Tenoksikam ve Rektal Lidokain Jel Anestezisinin Karşılaştırılması

Year 2009, Volume: 16 Issue: 3, 141 - 144, 01.06.2009

Abstract

Amaç: Bu çalışmada transrektal ultrasonografi (TRUS)-kılavuzluğunda prostat biyopsisi öncesi kullanılan üç farklı lokal anestezi yönteminin (pudental sinir bloğu, supozituar tenoksikam ve intrarektal lidokain jel) etkinlik ve güvenilirliği araştırıldı. Materyal ve metot: Prospektif ve kontrollü olan çalışmamızda toplam 136 hasta 4 gruba randomize edildi; grup 1'deki (n=41) hastalara anestezi uygulanmadı, grup 2'deki (n=30) hastalara biyopsiden 10 dk önce intrarektal 10 cc %2'lik lidokain jel, grup 3'deki (n=31) hastalarabiyopsiden 30 dk önce 20 mg supozituar tenoksikam, grup 4'deki (n=34) hastalara biyopsiden 10 dk önce 10 ml %1'lik lidokain kulanılarak pudental sinir bloğu uygulandı. Vizüel analog skala (VAS) kullanılarak hastalardan prob girişi ve biyopsi sırasındaki ağrıyı derecelendirmeleri (0-10 puan) istendi. Bulgular: Prob girişi (p=0.024) ve biyopsi (p=0.012) sırasındaki ortalama VAS skorları incelendiğinde 4 grup arasında istatistiksel olarak anlamlı fark mevcuttu. Bu sonuç grup 1 ve 4 arasındaki farktan kaynaklanıyordu (Tukey testinde prob girişi sırasında p=0.015 ve biyopsi sırasında p=0.022). Grup 1, 2 ve 3 arasında prob girişi ve biyopsi sırasındaki ortalama VAS skorları bakımından istatistiksel olarak önemli fark yoktu. Sonuç: Pudental sinir bloğu prob girişi ve biyopsi sırasındaki ağrıyı azaltmada etkili olurken supozituar tenoksikam ve intrarektal lidokain jelin önemli anestetik etkisine rastlanmamıştır. Anahtar kelimeler: Prostat Biyopsisi, Anestezi, Ağrı, Pudental Sinir Bloğu, Supozituar Tenoksikam

References

  • Crundwell MC, Cooke PW, Wallace DM. Patients' tolerance of transrectal ultrasound-guided prostatic biopsy: an audit of 104 cases: BJU Int 1999; 83: 792–5.
  • Obek C, Ozkan B, Tunc B, Can G, Yalcin V, Solok V. Comparison of 3 different methods of anesthesia before transrectal prostate biopsy: a prospective randomized trial. J Urol 2004; 172: 502–5.
  • Issa MM, Bux S, Chun T, Petros JA, Labadia AJ, Anastasia K, Miller LE, Marshall FF. A randomized prospective trial of intrarectal lidocaine for pain control during transrectal prostate biopsy: the Emory University experience. J Urol 2000; 164: 397– 9.
  • Adsan O, Inal G, Ozdoğan L, Kaygisiz O, Uğurlu O, Cetinkaya M. Unilateral pudendal nerve blockade for relief of all pain during transrectal ultrasound-guided biopsy of the prostate: a randomized, double-blind, placebo-controlled study. Urology 2004; 64: 528–31.
  • Haq A, Patel HR, Habib MR, Donaldson PJ, Parry JR. Diclofenac suppository analgesia for transrectal ultrasound guided biopsies of the prostate: a double-blind, randomized controlled trial. J Urol 2004; 171: 1489–91.
  • Olkkola KT, Brunetto AV, Mattila MJ. Pharmacokinetics of oxicam nonsteroidal anti-inflammatory agents. Clin Pharmacokinet 1994; 26: 107–20.
  • Inal G, Yazici S, Adsan O, Ozturk B, Kosan M, Cetinkaya M. Effect of periprostatic nerve blockade before transrectal ultrasound-guided prostate biopsy on patient comfort: a randomized placebo controlled study. Int J Urol 2004; 11: 148– 51.
  • Irani J, Fournier F, Bon D, Gremmo E, Doré B, Aubert J. Patient tolerance of transrectal ultrasound-guided biopsy of the prostate. Br J Urol 1997; 79: 608–10.
  • Autorino R, De Sio M, Di Lorenzo G, Damiano R, Perdonà S, Cindolo L, D'Armiento M. How to decrease pain during transrectal ultrasound guided prostate biopsy: a look at the literature. J Urol 2005; 174: 2091–7.
  • Davis M, Sofer M, Kim SS, Soloway MS. The procedure of transrectal ultrasound guided biopsy of the prostate: a survey of patient preparation and biopsy technique. J Urol 2002; 167: 566– 70.
  • Cevik I, Ozveri H, Dillioglugil O, Akdaş A. Lack of effect of intrarectal lidocaine for pain control during transrectal prostate biopsy: a randomized prospective study. Eur Urol 2002; 42: 217– 20.
  • Chang SS, Alberts G, Wells N, Smith JA Jr, Cookson MS. Intrarectal lidocaine during transrectal prostate biopsy: results of a prospective double-blind randomized trial. J Urol 2001; 166: 2178–80.
  • Schraffordt SE, Tjandra JJ, Eizenberg N, Dwyer PL. Anatomy of the pudendal nerve and its terminal branches: a cadaver study. ANZ J Surg 2004; 74: 23–6.
  • Gabrielli F, Cioffi U, Chiarelli M, Guttadauro A, De Simone M. Hemorrhoidectomy with posterior perineal block: experience with 400 cases. Dis Colon Rectum 2000; 43: 809–12.
  • Dos Reis JM, Glina S, Da Silva MF, Furlan V. Penile prosthesis surgery with the patient under local regional anesthesia. J Urol 1993; 150: 1179–81.
  • Rossier AB, Fam BA, Lee IY, Sarkarati M, Evans DA. Role of striated and smooth muscle components in the urethral pressure profile in traumatic neurogenic bladders: a neuropharmacological and urodynamic study. Preliminary report. J Urol 1982; 128: 529– 35.
  • McDonald JS, Spigos DG. Computed tomography-guided pudendal block for treatment of pelvic pain due to pudendal neuropathy. Obstet Gynecol 2000; 95: 306–9.
  • Kovacs P, Gruber H, Piegger J, Bodner G. New, simple, ultrasound-guided infiltration of the pudendal nerve: ultrasonographic technique. Dis Colon Rectum 2001; 44: 1381–5.
  • Choi SS, Lee PB, Kim YC, Kim HJ, Lee SC. C-arm-guided pudendal nerve block: a new technique. Int J Clin Pract 2006; 60: 553–6.
  • Shafik A, el-Sherif M, Youssef A, Olfat ES. Surgical anatomy of the pudendal nerve and its clinical implications. Clin Anat 1995; 8: 110–5.
  • Corresponding Author: Cüneyt ÖZDEN, MD
  • Cevizlidere Mah. 14. Cad. 12/25 06520 Balgat/ANKARA Tel: 05052729744
  • E -mail: cuneytozden@hotmail.com
There are 23 citations in total.

Details

Primary Language Turkish
Journal Section Articles
Authors

Süleyman Bulut This is me

Binhan Kağan Aktaş This is me

Cüneyt Özden; Özer Güzel This is me

Yaşar Pala This is me

Ali Memiş This is me

Publication Date June 1, 2009
Published in Issue Year 2009 Volume: 16 Issue: 3

Cite

APA Bulut, S., Aktaş, B. K., Güzel, C. Ö. Ö., Pala, Y., et al. (2009). Transrektal Ultrasonografi Kılavuzluğunda Prostat Biyopsisi İçin Pudental Sinir Bloğu, Supozituar Tenoksikam ve Rektal Lidokain Jel Anestezisinin Karşılaştırılması. Journal of Turgut Ozal Medical Center, 16(3), 141-144.
AMA Bulut S, Aktaş BK, Güzel CÖÖ, Pala Y, Memiş A. Transrektal Ultrasonografi Kılavuzluğunda Prostat Biyopsisi İçin Pudental Sinir Bloğu, Supozituar Tenoksikam ve Rektal Lidokain Jel Anestezisinin Karşılaştırılması. J Turgut Ozal Med Cent. June 2009;16(3):141-144.
Chicago Bulut, Süleyman, Binhan Kağan Aktaş, Cüneyt Özden; Özer Güzel, Yaşar Pala, and Ali Memiş. “Transrektal Ultrasonografi Kılavuzluğunda Prostat Biyopsisi İçin Pudental Sinir Bloğu, Supozituar Tenoksikam Ve Rektal Lidokain Jel Anestezisinin Karşılaştırılması”. Journal of Turgut Ozal Medical Center 16, no. 3 (June 2009): 141-44.
EndNote Bulut S, Aktaş BK, Güzel CÖÖ, Pala Y, Memiş A (June 1, 2009) Transrektal Ultrasonografi Kılavuzluğunda Prostat Biyopsisi İçin Pudental Sinir Bloğu, Supozituar Tenoksikam ve Rektal Lidokain Jel Anestezisinin Karşılaştırılması. Journal of Turgut Ozal Medical Center 16 3 141–144.
IEEE S. Bulut, B. K. Aktaş, C. Ö. Ö. Güzel, Y. Pala, and A. Memiş, “Transrektal Ultrasonografi Kılavuzluğunda Prostat Biyopsisi İçin Pudental Sinir Bloğu, Supozituar Tenoksikam ve Rektal Lidokain Jel Anestezisinin Karşılaştırılması”, J Turgut Ozal Med Cent, vol. 16, no. 3, pp. 141–144, 2009.
ISNAD Bulut, Süleyman et al. “Transrektal Ultrasonografi Kılavuzluğunda Prostat Biyopsisi İçin Pudental Sinir Bloğu, Supozituar Tenoksikam Ve Rektal Lidokain Jel Anestezisinin Karşılaştırılması”. Journal of Turgut Ozal Medical Center 16/3 (June 2009), 141-144.
JAMA Bulut S, Aktaş BK, Güzel CÖÖ, Pala Y, Memiş A. Transrektal Ultrasonografi Kılavuzluğunda Prostat Biyopsisi İçin Pudental Sinir Bloğu, Supozituar Tenoksikam ve Rektal Lidokain Jel Anestezisinin Karşılaştırılması. J Turgut Ozal Med Cent. 2009;16:141–144.
MLA Bulut, Süleyman et al. “Transrektal Ultrasonografi Kılavuzluğunda Prostat Biyopsisi İçin Pudental Sinir Bloğu, Supozituar Tenoksikam Ve Rektal Lidokain Jel Anestezisinin Karşılaştırılması”. Journal of Turgut Ozal Medical Center, vol. 16, no. 3, 2009, pp. 141-4.
Vancouver Bulut S, Aktaş BK, Güzel CÖÖ, Pala Y, Memiş A. Transrektal Ultrasonografi Kılavuzluğunda Prostat Biyopsisi İçin Pudental Sinir Bloğu, Supozituar Tenoksikam ve Rektal Lidokain Jel Anestezisinin Karşılaştırılması. J Turgut Ozal Med Cent. 2009;16(3):141-4.