A Randomized Controlled Comparison of Effects of Three Different Agents Used for Local Anesthesia in Transrectal UltrasoundGuided Prostate Biopsy

Objective: To evaluate the effects of three different local anesthetic agents in patients who underwent Transrectal ultrasoun guided prostate needle biopsy. Materials and Methods: One hundred and sixty patients who were admitted to our clinic between January 2012 and May 2012 for prostate biopsy were divided into 4 groups: no anesthesia-administered group (group 1), lidocaine-administered group (group 2), levobupivacaine-administered group (group 3) and bupivacaine-administered group (group 4). Pain intensity was evaluated in each group using the visual analog scale (VAS): during administration of local anesthetic (VAS 1), during the biopsy (VAS 2), just after the biopsy (VAS 3) and one hour after the biopsy (VAS 4). Results: There was not any significant difference among the groups in terms of VAS 1 (p=0.152). Pain scores were significantly lower during biopsy (VAS 2) in groups 1, 2 and 3 compared to that in group 1 (p=0.001, p=0.005 and p=0.007, respectively). VAS 3 scores were significantly lower in group 2 and group 3 compared to group 1 while no difference was found in group 4 (p=0.003, p=0.032, and p=0.136, respectively). VAS 4 scores were significantly lower only in group 3 compared to group 1 (p=0.001). Conclusions: It was observed that all the three local anesthetics effectively diminished pain during prostate biopsy. However, we found that levobupivacaine, which improved pain scores in all steps of pain evaluation compared to the control group, was relatively superior for pain management in the transrectal biopsy setting.

Transrektal Ultrason Kılavuzluğundaki Prostat Biyopsisinde Kullanılan Üç Farklı Anestezik Ajanın Etkinliklerinin Randomize Kontrollü Karşılaştırılması

Amaç: Bu çalışmada transrektal ultrason kılavuzluğunda prostat biyopsisi alınan hastalarda kullandığımız üç farklı lokal anestezik ajanın etkilerini değerlendirdik. Gereç ve Yöntem: Ocak 2012-Mayıs 2012 tarihleri arasında kliniğimizde prostat biyopsisi uygulanan 160 hasta dört gruba ayrıldı; anestezi kullanılmayan grup (grup 1), lidokain kullanılan grup (grup 2), bupivakain kullanılan grup (grup 3) ve bupivakain kullanılan grup (grup 4). Her grupta ağrı skorları vizüel analog skala (VAS) kullanılarak ölçüldü; lokal anestezik ajanın uygulanması sırasındaki ağrı skoru (VAS 1), biyopsi sırasındaki ağrı skoru (VAS 2), biyopsiden hemen sonraki ağrı skoru (VAS 3) ve biyopsiden bir saat sonraki ağrı skoru (VAS 4). Bulgular: VAS 1 için gruplar arasında anlamlı bir fark bulunmadı (p=0,152). VAS 2 için anestezi uygulanan her 3 gruptaki ağrı skorları anestezi uygulanmayan gruba göre anlamlı olarak düşüktü (p değerleri sırasıyla: 0,001, 0,005, 0,007). VAS 3 skorları grup 2 ve grup 3’te anestezi uygulanmayan gruba göre anlamlı olarak düşükken grup 4 için anlamlı bir fark saptanmadı (p değerleri sırasıyla: 0,003, 0,032, 0,136). VAS 4 ağrı skorları anestezi uygulanmayan grupla karşılaştırıldığında sadece grup 3 için anlamlı olarak düşük bulundu (p=0,001). Sonuç: Kullandığımız üç lokal anestezik ajanın da yapılan prostat biyopsileri sırasında oluşan ağrıları etkili bir şekilde azalttığı gösterilmiştir. Bununla beraber ağrının değerlendirildiği her üç aşamada da kontrol grubuna göre ağrı skorlarını anlamlı şekilde azaltan levobupivakainin bu ajnalar içerisinde bir adım öne çıktığı görülmüştür. Bu nedenle daha etkili bir ajan olarak levoupivakainin kullanımı öneriyoruz.

Kaynakça

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