A comparison of pain control and complications using three different ways of anesthesia in patients undergoing transrectal ultrasound?guided prostate biopsy

Hamid Mazdak, Amir Mohamad Abtahi, Fatemeh Momeni, Mohammad Hossein Izadpanahi


Background: We aim to compare the degree of pain control and  complications in three types of anesthesia using periprostatic  nerve block (PPNB) plus intrarectal local anesthesia (IRLA), low?dose spinal anesthesia, and intravenous (IV) sedation in patients undergoing transrectal ultrasound (TRUS)?guided prostate biopsy. Materials and Methods: In this clinical trial study, 106 patients were participated from December 2015 to December 2016 at Alzahra Hospital, Isfahan, Iran. Patients were randomly allocated into three groups to receive PPNB plus IRLA (n = 36), low?dose spinal anesthesia (n = 35) and IV sedation (n = 35) before TRUS?guided
prostate biopsy. Pain scores were recorded using a 10 point visual analog scale right after the biopsy was done. Early and late complications were assessed using a questionnaire after the procedure and in follow?up of patients. Results: Overall, the pain score in the low?dose spinal anesthesia group was signifcantly lower than PPNB plus IRLA and IV sedation groups (P < 0.001). Te di?erences in pain scores between PPNB plus IRLA group and IV sedation group were not signifcant (P = 0.30). Urinary retraction
and fever were signifcantly more frequent in low?dose spinal anesthesia and IV sedation, retrospectively (P = 0.04, P = 0.03). No signifcant di?erence in late complications was found among the groups. Conclusion: Tis study demonstrates that low?dose spinal anesthesia is superior to PPNB plus IRLA and IV sedation in terms of pain controlling and was associated with higher tolerance of the examination and patient comfort.


Intravenous sedation, nerve block, pain, prostate biopsy, spinal anesthesia, trans rectal ultrasonography

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