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.