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Caudal and Peri-Anal Nerve Block during Finger-Guided Transrectal Prostate Biopsy: A Randomized Single Blind Study

Patrick Temi Adegun*, Michael Jide Afolayan, Peter Olufemi Areo, Julius Gbenga Olaogun and Emmanuel Abidemi Omonisi

Background: Several studies have demonstrated the efficacy of caudal block in prostate biopsy but none has shown the efficacy of peri-anal nerve block. We aimed to compare the efficacy and tolerability of caudal and peri-anal nerve block in finger-guided prostate biopsy.

Methods and materials: Patients undergoing prostate biopsy were randomised by single blinding into 2 groups. Group 1 were biopsy done under caudal block (20 ml of 1% lignocaine with adrenaline) and Group 2 were those done under peri-anal nerve block (20 ml of 1% lignocaine with adrenaline). Visual analogue pain measurement was used to assess the pains of the patient at different stages of the procedure. Cooperativeness was assessed by a trained observer and graded accordingly.

Results: The groups were comparable in clinical details as demonstrated in age, BMI, duration of procedure and patients cooperativeness, P>0.05. Middle aged men had worse post procedure pain in group 2, p=0.032. Pain perception during biopsy was not significantly different in the two groups (P>0.05). We did not observe any statistically significant difference when level of cooperativeness was cross tabulated with the anaesthetic techniques (P=0.976). Cancer detection rate was 58.7% and 55.6% for caudal and perianal block respectively. Intercurrences suggestive of increased morbidity associated with the techniques were not observed.

Conclusions: The use of 20 ml of 1% Lignocaine with adrenaline for perianal block was capable of reducing the discomfort and pain associated with prostate biopsy and was quite compatible with the caudal protocol.