Low Dose Spinal Saddle Block Anesthesia (With 1.5 Mg Bupivacaine) For Transrectal Prostate Biopsy-Experience with 120 Cases

Abstract

Objective: To share our experience on the use of low dose spinal saddle block anesthesia (SSBA) for prostate biopsy. Methods: The efficacy of low dose SSBA using 1.5 mg of 0.5% bupivacaine in dextrose injection USP was evaluated in 120 patients undergoing transrectal prostate biopsy. Pain score, patient's cooperativeness, and willingness to have a repeat biopsy was assessed. Also assessed were patients age, prostate volume, Prostate specific antigen (PSA), biopsy cores, complications, blood pressure (BP) changes, duration and cost of the procedure. Results: The mean patient age (yrs) was 63.3 (± 8.98), Mean pain Score was 0.0 ± 0.2 (range 0-1). There were no anesthetic complications. Mild complications related to prostate biopsy occurred in 65% of patients while the remaining 35% of patients had no complications. There was no mortality. All patients were very cooperative during the procedure and 100% of them were willing to have a repeat biopsy should the need arise. Mean PSA (ng/ml) was 39.6 ± 45.6, mean prostate volume (cm 3) was 109.5 ± 46.1, mean biopsy cores taken was 12.6 ± 0.8, mean systolic BP change (mmHg) was 8.6 ± 5.4. Duration of biopsy (minutes)was 35.6 ± 5.8. There were no motor deficits. All Patients were able to position themselves for biopsy and walk immediately after biopsy and go home within one hour of biopsy. Conclusions: Properly administered low dose spinal saddle block anesthesia offers definite anesthesia for prostate biopsy without motor deficits or appreciable drop in systolic BP from baseline. It has high levels of patient cooperativeness and willingness to have a repeat biopsy. It could be an alternative anesthetic technique for prostate biopsy.