Prospective Randomized Trial of Spinal Saddle Block Versus Periprostatic Lignocaine for Anesthesia During Transrectal Prostate Biopsy

OBJECTIVE To compare the efficacy and tolerability of spinal saddle block vs periprostatic lignocaine injection for anesthesia during transrectal prostate biopsy. METHODS A total of 75 patients were randomized to undergo prostate biopsy in 3 groups (n = 25). Group 1 had no anesthesia, group 2 had periprostatic lignocaine injection, and group 3 had spinal saddle block. All patients had sextant biopsy. The groups were assessed for pain, level of cooperativeness, willingness to have a repeat biopsy, complication rate, and the duration of the procedure. RESULTS The mean age in the groups were, respectively, 65.0 (+/- 5.7) (group 1), 65.5 (+/- 9.3) (group 2), and 68.6 (+/- 6.3) (group 3) years. There was no statistical difference between the groups with respect to age, prostate volume, number of biopsies taken, and the prostate-specific antigen. The mean visual analog score in the groups was, respectively, 5.7 (+/- 2.3), 4.6 (+/- 2.3) and 0.7 (+/- 1.6) for groups 1-3. The difference between groups 1 and 2 was not statistically significant (P = .181), whereas the difference between groups 2 and 3 and groups 1 and 3 was highly statistically significant (P = .000). There were also highly statistically significant differences in levels of cooperativeness and duration of the procedure between group 3 and groups 1 and 2. The differences between the groups with respect to complication rates and willingness to have a repeat biopsy were not statistically significant. CONCLUSIONS Spinal saddle block was a more effective method of anesthesia than periprostatic lignocaine. It did not sacrifice the current outpatient/day case setting for prostate biopsy. It could be offered routinely to patients undergoing prostate biopsy. UROLOGY 77: 280-285, 2011. Crown Copyright (C) 2011 Published by Elsevier Inc.