Comparative evaluation of spinal anaesthesia and transrectal ultrasound guided peri-prostatic block for patients undergoing transurethral resection of prostate

Background and Aim: Transurethral resection of prostate (TURP) is the most common surgical intervention for patients with benign prostatic hyperplasia. Patients undergoing TURP are usually elderly with associated co-morbidities, thus sedoanalgesia (local anaesthesia with sedation) seems to be a promising option with faster recovery and shorter hospitalisation. Against this background, the aim of our study was to compare the safety and efficacy of sedoanalgesia with the conventionally used spinal anaesthesia for transurethral resection of prostate.
Methods: This prospective randomized study was conducted in 100 patients (aged 50-80 years), with a prostatic volume of 30-70 cc and with duration of surgery less than 60 minutes undergoing TURP. Patients were randomly allocated into two groups: Group S (n=50): received spinal anaesthesia with 2ml of 0.5% hyperbaric bupivacaine; Group B (n=50): received sedatives alongwith prostatic block under transrectal ultrasound guidance by infiltration of 20 ml of 1% lignocaine without adrenaline into the prostate and periprostatic area. VAS scores, hemodynamic parameters and patient satisfaction were recorded.
Results: Demographic profile, prostate volume and duration of surgery were comparable between the two groups. VAS scores were significantly lower in Group S as compared to Group B throughout the intraoperative period (p=0.01). The hemodynamic parameters were maintained better in Group B. All 50 patients were satisfied with the anaesthetic technique in Group S while 46 out of 50 patients were satisfied in Group B.
Conclusion: USG guided prostatic block is a promising option in elderly patients especially with various comorbidities and those with contraindications to spinal anaesthesia.