A NEW METHOD OF ANAL ANALGESIA FOR TRANSRECTAL PROSTATE BIOPSY IN PATIENTS WITH ANO-RECTAL ABNORMALITIES
Evaluate the effectiveness of a new anal anesthesia, combined with the standard periprostatic infiltration for transrectal prostate biopsy, in order to obtain the best analgesic effect in patients with anal disorders
Materials and Methods
From January 2014 to January 2015, 35 consecutive patients with ano-rectal comorbidity were selected (13 stenosis, 16 hypertonic sphincterer, 6 anal fissure) to undergo a transrectal prostate biopsy.
This new aesthetic technique provides an infiltration of total 10 ml of lidocaine in the anal submucosa at the four cardinal points; a one minute finger massage of the orifice completes the procedure.
According to different cases, a relaxation of the sphincter hypertone or rather a mechanical dilatation of the anal orifice is sufficient to obtain a painless penetration of the probe.
A standard periprostatic anesthesia is then provided.
Every step of the procedure was registered on a VAS (Visual Analogue Scale).
At the moment of discussion of the biopsy results, a questionnaire was given about analgesic satisfaction and possible alterations of the alveus.
Pain during the anesthetic infiltration was significant (VAS 4.5), mainly with the first injection, with gradual reduction with the following ones (VAS-I a 7.4 vs VAS-I b 4.7, VAS-Ic 3.6 vs VAS-Id .5).
Pain during the probe injection was negligible (VAS 0.8).
Pain registered during the periprostatic injection was 1.89.
The control of the pain was 0.43 during the sampling.
The anal anaesthesiological technique caused vagal manifestation in 3.5%, and anal bleeding (however auto-limiting) in 11.4 %.
Only in two cases was not possible to complete the anaesthesiological anal procedure: in the first case because of a severe anal stenosis and in the second case because of the patient’s decision to interrupt the procedure.
Percentage of general complications related to the procedure didn’t differ from the average ones.
Moreover, data from the questionnaire show a global satisfaction of 90% and an acceptance to eventually repeat the procedure with analogous methods of 80,7% (growing up to 100% in a subgroup subjected to a previous prostatic biopsy in other centers).
Ano-rectal abnormalities, more frequently summarized in the anal stenosis and in the sphincteral hypertone, are responsible of the amplification of algogenic stimulus and result in reduction of the patient's compliance for the bioptic procedure.
This often makes necessary postponing the biopsy in order to obtain the suitable preparation of the anal orifice, or rather the recourse to a delayed hospitalization linked to general or spinal anesthesia. All the above can obviously cause an increase in time and costs and sometimes the abortion of the biopsy by the patient.
On the other hand, such a procedure was proven to be easy to perform and easily reproducible.
Results of VAS show its effectiveness during either the introduction of the probe or during the sampling itself.
The perianal anesthesia technique for infiltration of lidocaina in to the submucosa, should be considered an effective analgesic aid for patients with ano-rectal comorbidities such as anal stenosis , sphincteral hypertone and anal fissure.
This procedure was proven to be easy to perform and easily reproducible, with out the need of postponing the biopsy in order to obtain the suitable preparation of the anal orifice, or rather the recourse to a delayed hospitalization linked to general or spinal anesthesia.
Furthermore results of visual analog scale show its effectiveness during either the introduction of the probe or during the sampling itself.
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