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Transrektal ultrasonografi kılavuzluğunda yapılan prostat biyopsisinde anestezi şekli, hasta yaşı ve prostat hacminin ağrı üzerine etkisi

The effects of the type of anesthesia, age of the patient and prostate volume on the degree of pain perceived during prostate biopsy performed under transrectal ultrasonography guidance

Journal Name:

  • Gülhane Tıp Dergisi

Publication Year:

  • 2008

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Abstract (2. Language): 
Factors affecting the sense of pain perceived during prostate biopsy performed under transrectal ultrasonography guidance in patients with high prostate specific antigen level or abnormal digital rectal examination findings were investigated in this study. Four different types of anesthesia were performed on 210 patients in whom prostate biopsy was taken at our clinic. Topical anesthesia with perianal lidocaine cream, local block with perianal lidocaine injection, perianal lidocaine cream plus intrarectal lidocaine gel and perianal lidocaine cream plus anal dilation by finger were administered in Groups 1, 2, 3 and 4, respectively. Prostate volumes of the patients were measured by transrectal ultrasonography. Pain perceived during biopsy and placement of the transrectal ultrasonography probe into rectum was questionned by visual analog scale. Fifty, 80, 40 and 40 out of 210 patients comprised Groups 1, 2, 3 and 4, respectively. Mean age of the groups was 62.70±9.15, 65.80±7.93, 63.11±8.32 and 62.70±8.48 years; mean prostate volume of the groups was 58.87±29.84, 56.69±28.91, 49.44±22.82 and 61.46±21.84 cc; mean prostate specific antigen level of the groups was 9.74±9.36, 12.0±15.05, 7.71±2.91 and 11.12±13.82 ng/ml, respectively, and no statistically significant differences were observed among the groups (p=0.157, p=0.458 and p=0.547, respectively). Pain perceived during the placement of transrectal ultrasonography probe into rectum was 0.60±0.88, 0.83±1.06, 0.22±0.44 and 0.58±0.84, respectively, and independent from the type of anesthesia (p=0.242). Pain perceived during biopsy was 1.39±0.94, 1.70±0.96, 2.22±1.39 and 1.51±0.99, respectively, and also independent from all four types of anesthesia (p=0.170). There was no correlation between prostate volume and age and pain score (p>0.05). According to our results, neither of four different types of anesthesia we performed during biopsy under the guidance of transrectal ultrasonography showed superiority to others regarding pain score. Age of the patient and prostate volume had also no effect on the pain score.
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Abstract (Original Language): 
Bu çalışmada prostat spesifik antijen yüksekliği veya parmakla rektal incelemede anormallik saptanan ve transrektal ultrasonografi eşliğinde biyopsi alınan hastalarda ağrı duyusuna etki eden faktörler araştırıldı. Kliniğimizde prostat biyopsisi alınan 210 hastaya işlem öncesi 4 farklı anestezi tekniği uygulandı. Birinci gruba perianal topikal lidokainle lokal anestezi, 2. gruba perianal infiltrasyonla lokal blok, 3. gruba perianal lokal lidokaine ilave intrarektal lidokain jel ve 4. gruba perianal lidokaine ilave parmakla anal dilatasyon uygulandı. Hastaların prostat hacimleri transrektal ultrasonografi ile ölçüldü. Vizüel analog skala kullanılarak biyopsi sırasında ve ultrasonografi probunun yerleştirilmesi sırasında oluşan ağrı duyusu sorgulandı. İki yüz on hastadan 50'si birinci grupta, 80'i ikinci grupta, 40'ı üçüncü grupta ve 40'ı da dördüncü grupta yer aldı. Grupların yaş ortalamaları sırasıyla 62.70±9.15, 65.80±7.93, 63.11±8.32 ve 62.70±8.48 yıl, prostat hacimleri sırasıyla 58.87±29.84, 56.69±28.91, 49.44±22.82 ve 61.46±21.84 cc, prostat spesifik antijen değerleri de sırasıyla 9.74±9.36, 12.0±15.05, 7.71±2.91 ve 11.12±13.82 ng/ml idi ve istatistiksel olarak birbirlerinden farklı değildi (sırasıyla p=0.157, p=0.458 ve p=0.547). Ultrasonografi probunun yerleştirilmesi esnasında duyulan ağrı skoru ortalamaları sırasıyla 0.60±0.88, 0.83±1.06, 0.22±0.44, 0.58±0.84 idi ve anestezi şeklinden bağımsızdı (p=0.242). Biyopsi alımı sırasında duyulan ağrı da sırasıyla 1.39±0.94, 1.70±0.96, 2.22±1.39, 1.51±0.99 olarak hesaplandı ve her dört anestezi şeklinden bağımsız olarak bulundu (p=0.170). Yaş ve prostat hacmi ile de ağrı skoru arasında korelasyon saptanmadı (p>0.05). Bizim sonuçlarımıza göre transrektal ultrasonografi eşliğinde biyopsi alınması sırasında uyguladığımız dört farklı anestezi şeklinden hiçbirisinin ağrı skoru açısından diğerlerine üstünlüğü gösterilememiştir. Hasta yaşı ve prostat hacminin de ağrı skoru üzerine etkisi bulunmamıştır.
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