Caudal analgesia for prostate biopsy.
BACKGROUND
Although various local anesthesia techniques have been suggested to decrease pain and discomfort during a transrectal ultrasound (TRUS)-guided prostate biopsy, the best method has not yet been defined. The present prospective, double-blind, randomized study aims to investigate the clinical efficacy of 'walking' caudal block compared with an intrarectal lidocaine gel for this procedure.


METHODS
One hundred patients were randomly assigned to two groups. In the lidocaine gel group, 10 ml of gel containing 2% lidocaine was given intrarectally. In the caudal group, 20 ml 0.1% bupivacaine with 75 microg fentanyl was injected. Pain scores, anal sphincter tone and patient satisfaction were evaluated.


RESULTS
The pain scores were significantly lower in the caudal group at all stages. Verbal rating scores (scale 1-4) during probe insertion, probe maneuver and biopsies were 1 (0-2), 1 (0-2) and 1 (0-2) vs. 3 (0-5), 2 (1-3) and 4 (2-6), respectively (P value <0.0001 at all stages). The anal sphincter was more relaxed in the caudal group than in the gel group (P value <0.0001 in all categories). Highly satisfied patients were more frequently encountered in the caudal group, 34 (68%) vs. 8 (16%), P<0.0001, and unsatisfied patients were more frequently found in the gel group 1 (2%) vs. 12 (24%); P<0.001. All patients were able to walk without any assistance immediately after the procedures.


CONCLUSIONS
'Walking' caudal analgesia is an efficacious method for relieving the pain during TRUS-guided prostate biopsies in ambulatory practice.
Cesur
M
M
Department of Anesthesiology and Reanimation, Medical Faculty, Ataturk University, Erzurum, Turkey. mcesur68@gmail.com
Yapanoglu
T
T
Erdem
A F
AF
Ozbey
I
I
Alici
H A
HA
Aksoy
Y
Y
D000368:Aged; D000553:Ambulatory Care; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000763:Anesthesia, Caudal / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001706:Biopsy; D002045:Bupivacaine / Q000008:administration & dosage*; D004311:Double-Blind Method; D005283:Fentanyl / Q000627:therapeutic use; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D010147:Pain Measurement; D017060:Patient Satisfaction; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D036761:Ultrasound, High-Intensity Focused, Transrectal / Q000379:methods
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D008012:Lidocaine; D005283:Fentanyl; D002045:Bupivacaine