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

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

Keywords

• Prostate Biopsy, Anesthesia, Pain, Pudendal Nerve Blockade, Tenoxicam Suppository

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

Öz

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

Anahtar Kelimeler

• Prostat Biyopsisi, Anestezi, Ağrı, Pudental Sinir Bloğu, Supozituar Tenoksikam

Kaynakça

1. 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.
2. 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.
3. 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.
4. 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.
5. 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.
6. Olkkola KT, Brunetto AV, Mattila MJ. Pharmacokinetics of oxicam nonsteroidal anti-inflammatory agents. Clin Pharmacokinet 1994; 26: 107–20.
7. 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.
8. 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.

9. 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.
10. 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.
11. 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.
12. 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.
13. 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.
14. 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.
15. 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.
16. 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.
17. McDonald JS, Spigos DG. Computed tomography-guided pudendal block for treatment of pelvic pain due to pudendal neuropathy. Obstet Gynecol 2000; 95: 306–9.
18. 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.
19. 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.
20. 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.
21. Corresponding Author: Cüneyt ÖZDEN, MD
22. Cevizlidere Mah. 14. Cad. 12/25 06520 Balgat/ANKARA Tel: [phone]
23. E -mail: [e-mail]