Comparison of Sedation With Local Anesthesia and Regional Anesthesia in Transurethral Resection of Prostate (TURP)

Introduction &

Transurethral Resection of Prostate (TURP) is usually performed under regional or general anesthesia. An alternative to conventional anesthesia is performing of TURP under local anesthetic infiltration with sedation. The aim of this study was to evaluate the efficacy and complication of sedoanalgesia in TURP.

In a prospective clinical trial from September 2006 to December 2007, 60 patients (30 in each group) with prostate hypertrophy, candidate for TURP, were randomly assigned into two groups. In the first group, standard spinal anesthesia was done. In the second group, five minutes before the operation, 25 mgs of diazepam plus 25-50 mgs of pethedine was intravenously administered followed by injection of 10 ml lidocaine 2% gel in the urethra and the skin in the suprapubic area was anesthetized with 2 ml of 1% lidocaine. Using a 22 gauge nephrostomy needle, the suprapubic skin was punctured and the needle was directed toward prostate apex and 10-20ml of 1% lidocaine was injected at the serosal aspect of the rectal wall. For dorsal nerve block, 5-10ml of 1% lidocaine was injected at penopubic junction, and then a standard TURP was performed. Patients were switched to another anesthetic technique if the selected technique failed. Severity of pain was assessed by visual analogue scale.

The average prostate size was 25 grs (range10-50grs) in the local anesthetic group (group 1) and 27.5 grs (range 10-50 grs) in the spinal group (group2). In the local anesthetic group, 82.3% had no or mild pain while moderate to severe pain was reported in 16, 7% of the patients. In the group with spinal anesthesia, these were 93.1% and 6.9% respectively. Intolerable pain was observed in 23.3% and 13.8% of groups 1 and 2 respectively (p>0.05). Two patients in spinal group and 5 in local anesthetic group (3 due to severe pain and 2 for unsatisfaction) required conversion to general anesthesia or receiving additional drugs such as ketamine (p=0.06). Postoperatively, 2 patients experienced headach following spinal anesthesia; otherwise there was no significant difference between two groups.

local anesthetic TURP with sedation is safe, effective and suitable for patients with prostate glands below 50 gr who require TURP.