Transurethral resection of the prostate (TURP) is one of the commonest procedures undertaken by urologists. There are well known complications following the procedure which commonly include haematuria but also TUR syndrome, failure to pass urine and infections, amongst others. The issue of pain has been addressed by this prospective, randomised, placebo-controlled, double-blind study from a group in Turkey. Fifty patients aged 50 to 87 who developed pain post TURP once the spinal anaesthesia had worn off were randomised to receive 30ml of either 2% prilocaine or physiological saline injected into the 3L bags of irrigation fluid used for haematuria. The pharmacokinetics of prilocaine with its short half life, rapid hepatic metabolism and rate of tissue distribution were favoured over other anaesthetic agents. There was no statistical difference in surgical parameters between the two groups. Only 2 out of 25 patients in the prilocaine group had persistent pain (8%) compared to 23 patients in the control group (92%). There was a statistical significant difference in the mean visual analogue pain score of 0.35 and 5.10 in the prilocaine and control groups, respectively. There was no obvious difference in the mean number of irrigation bags used for irrigation per patient between the two groups. However, the mean time to catheter removal and length of stay was slightly shorter for the prilocaine group. Systemic toxicity due to absorption of the anaesthetic which may be anticipated with ongoing haematuria was not reported. The use of anaesthetic agents in irrigation fluid over conventional simple and opioid analgesics certainly seems to be a novel way of managing postoperative pain from TURP. However, the authors were not able to describe the type and characteristics of the pain being treated. The spasms associated with an indwelling catheter are likely to be the commonest cause for postoperative pain. In those situations the use of an antispasmodic may be of similar or better efficacy but a comparative study between the two methods is first required to determine this.
Prilocaine irrigation for pain relief after TURP
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