Hasan TURGUT, Hasan Rıza AYDIN, Şenol ADANUR, Tevfik ZİYPAK, Murat BAĞCIOĞLU, Mansur DAĞGÜLÜ

Transrektal prostat biyopsisinde anestezi seçimi: Rektal lidokain jel instillasyonu ve lidokainle periprostatik sinir blokajı karşılaştırması

Amaç: Prostat patolojilerinin benin ya da malin ayrımının kesin olarak yapılabilmesi için prostat biyopsisi altın standarttır. Ancak işlem sırasında duyulan ağrı ciddi bir sorun teşkil etmektedir. Bu çalışmanın amacı; iki farklı yöntemle transrektal ultrasonografi TRUS rehberliğinde, prostat biyopsisi sırasında duyulan ağrının derecesine etkili olabilecek anestezi tekniklerini karşılaştırmaktırGereç ve Yöntemler: Kliniğimizde prostat spesifik antijen PSA yüksekliği ve parmakla rektal muayenede şüpheli bulgusu olan toplam 92 hastaya prostat biyopsisi yapıldı. Hastaların duydukları ağrı vizüel analog ağrı skalası VAS şekil 1 ile değerlendirildi. İşlem, hastalara lateral dekübitis pozisyonunda 7 MHz transrektal ultrason probu eşliğinde, 18 G Tru-cut otomatik biyopsi ataçmanları kullanılarak yapıldı. Bir gruba TRUS probunun yerleştirilmesinden 5 dakika önce rektum içine 10 ml %2’ lik Lidokain HCL jel verildi. Diğer gruba yine işlem öncesi %2’lik lidokain HCL jel ve periprostatik sinir blokajı yapılmak üzere sağ ve sol lop için ayrı ayrı 5 cc lidokain enjeksiyonu yapıldı.Bulgular: Hiçbir hasta şiddetli veya dayanılmaz ağrı tarif etmedi. Gruplar VAS skorları dikkate alınarak karşılaştırıldığında sinir blokajı yapılan hastalar lehine anlamlı fark belirlendi p

Anahtar Kelimeler:

Prostat biopsisi, Rektal lidokain jel anestezisi, Periprostatik sinir blokajı

Anesthesia selection in transrectal prostate biopsy: Comparison with lidocaine periprostatic nerve blocka- de and rectal instillation of lidocaine gel

Objectives: Prostate biopsy is the gold standard for distinction of benign or malign pathologies of the prostate with certainty. However, pain is a serious problem during the procedure. The aim of this study was to compare the anesthetic techniques which may affect the degree of the pain during prostate biopsy, with two different methods guided with transrectal ultrasonography TRUS . Materials and Methods: Prostate biopsy was performed for a total of 92 patients with high prostate-specific antigen PSA and a spicious findings with rectal examination. The pain of the patients was evaluated with visual analog pain scale VAS . The process was made for the patients with lateral decubitus position with 7 MHz transrectal ultrasound probe, 18 G automatic Tru-cut biopsy attachments. In one group, 5 minutes before the TRUS probe insertion 10 mL of 2% lidocaine HCL gel was inserted into the rectum. For the other group, HCL 2% lidocaine gel before the procedure again, and for peri-prostatic nerve block 5 cc of lidocaine was injected separately for the left and right lobe. Results: None of the patients had described severe or excruciating pain. Significant differences was observed with patient streated with rectal lidocain gel for VAS pain score compared with peri-prostatic nerve blockade after rectal lidocain gel p

Keywords:

Prostate biopsy, rectal lidocaine gel anesthesia, periprostatic nerve blockade,

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