Safety and efficacy of transurethral resection of the prostate under sedoanalgesia.
OBJECTIVE
To assess the safety and efficacy of sedoanalgesia (local anaesthesia with sedation) in patients with benign prostatic hyperplasia (BPH) undergoing transurethral resection of the prostate (TURP).


METHODS
The study comprised 50 patients with BPH, two-thirds of whom were graded III-IV using the American Society of Anesthesiologists system. All patients had a topical instillation of lignocaine jelly 2% into their urethra, combined with 1% lignocaine (100-200 mg) with 1 : 400 000 adrenaline infiltration of the prostate via the perineal route. Sedation and anxiolysis were obtained with the intramuscular pethidine (0.5 mg/kg) and promethazine (1 mg/kg). Standard TURP was then carried out, with pain monitored during surgery using a visual analogue scale (VAS, maximum 10 points) and the amount of analgesic required after TURP recorded. The amount of prostatic tissue excised, duration of surgery, blood requirement, catheter interval, complications and hospital stay were recorded. The effectiveness of TURP was assessed by comparing symptom scores, uroflowmetry and postvoid residual volume before and after surgery.


RESULTS
The mean intraoperative VAS was < or = 1 at any time during or after surgery; no patient required any postoperative analgesics. Only two patients complained of discomfort during the procedure and even they were comfortable after a supplemental dose of pethidine (12.5 mg). There were no conversions to general or regional anaesthesia. No blood transfusion was required in any patient. All patients began a normal diet 30 min after surgery and all were discharged within 48 h of surgery. There were no deaths; one patient had transient urinary incontinence and three had mild urinary tract infection.


CONCLUSIONS
Sedoanalgesia was an effective, safe and simple alternative to general or regional anaesthesia for TURP in patients with BPH.
Department of Surgery, Maulana Azad Medical College and Lok Nayak Hospital, Delhi, India MS.
J
J
Chander
U
U
Gupta
R
R
Mehra
V K
VK
Ramteke
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local / Q000379:methods*; D016292:Procedural Sedation / Q000379:methods*; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D010147:Pain Measurement; D011470:Prostatic Hyperplasia / Q000601:surgery*; D020728:Transurethral Resection of Prostate / Q000379:methods*