[Pudendal block or combined spinal-epidural anaesthesia in high-dose-rate brachytherapy for prostate carcinoma?].
OBJECTIVE
In male patients the pudendal block has been applied only in rare cases as a therapy for neuralgia of the pudendal nerve. Up to now there is no comparison of pudendal block with an anaesthesia form close to the spinal cord. In this pilot study the bilateral perineal infiltration of the pudendal nerve was compared to combined spinal-epidural anaesthesia in high-dose-rate (HDR) brachytherapy.


METHODS
In 30 patients (68.8 +/- 5.4 years) who underwent a core needle biopsy for high-risk prostate carcinoma, an HDR brachytherapy in CSE or NPB was carried out. Both anaesthesia forms were examined concerning the perioperative compatibility, the subjective feeling (German school marks principle 1-6), the pain feeling (VAS, 1-10) and the early postoperative course (mobility, complications).


RESULTS
Both anaesthesia procedures were offered to all patients. For 2 patients the NPB was favoured primarily, because they had undergone surgery of the lumbal spine, so that the CSE was not applicable. There was no change of anaesthesia form necessary. The expense of time for NPB was 10.5 +/- 2.5 min, for CSE 30.5 +/- 5.5 min (p < 0.005). The hollow needles remained in place on average for 79 +/- 11.7 min (p = 0.23). Inter- and postoperative pain feelings were in both groups between 1.3 +/- 1.1 and 1.1 +/- 1.0 (p = 0.61 and p = 0.29). The difference is not significant. The NPB group considered postoperative mobility as an advantage. All patients felt the bladder catheter as annoying, but the NPB group considered postoperative mobility as more important than complete lack of pain. The subjective feeling in the NPB group was described as 2.06 +/- 0.59 and in the CSE group 2.73 +/- 0.79. This is a significant difference (p < 0.005). No side effects or complications in both anaesthesia forms appeared.


CONCLUSIONS
The perineal pudendal block is equivalent to epidural anaesthesia in HDR brachytherapy. Concerning the objectifiable pain score measurement and the subjective feeling there are no essential significant differences.
Schenck
M
M
Urologische Universitätsklinik, Universitätsklinikum der Universität Duisburg-Essen, Hufelandstrasse 55, Essen. marcus.schenck@uni-due.de
Kliner
S J
SJ
Achilles
M
M
Schenck
C
C
Berkovic
K
K
Ruebben
H
H
Stuschke
M
M
D000368:Aged; D000767:Anesthesia, Epidural / Q000379:methods*; D001707:Biopsy, Needle; D001918:Brachytherapy / Q000295:instrumentation*; D004434:Early Ambulation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009407:Nerve Block / Q000295:instrumentation*; D010147:Pain Measurement; D010342:Patient Acceptance of Health Care; D010865:Pilot Projects; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D011882:Radiotherapy, High-Energy / Q000295:instrumentation*