Saddle Block for Transrectal Prostate Biopsy: A Comparison of the Analgesic Efficacy of 0.25% Bupivacaine and 0.375% Ropivacaine

  • JO Bamigboye
  • SO Olateju
  • AF Faponle
  • AA Salako
Keywords: Analgesia, Bupivacaine, Pain assessment, Ropivacaine, Saddle block, Transrectal Prostate Biopsy


Background: Prostate biopsy is a painful procedure, and the degree of pain is related to the number of core biopsies taken.

Objective: To compare the analgesic properties of hyperbaric bupivacaine 0.25% with 0.375% ropivacaine for saddle block in transrectal prostate biopsy.

Methods: This was a randomised double-blinded study. Eighty patients with indications for prostate biopsy presenting at the Day-Case Theatre in a Nigerian tertiary facility were randomised into two equal groups: B (Bupivacaine) and R (Ropivacaine). Group B received 1ml of 0.25% bupivacaine, while Group R received 1ml of 0.375% ropivacaine for saddle block, respectively. Pain assessment, home readiness, patients' satisfaction, and time to first analgesic request were assessed and compared between the two groups.

Results: The Bupivacaine group had an earlier onset of sensory block (11.90±4.10 minutes vs 23.70±8.65 minutes, p = 0.000), slower sensory block regression (48.73±9.32 minutes vs 24.88±4.21 minutes, p = 0.000), but delayed home readiness (47.23±15.93 minutes vs 29.88±8.58 minutes, p = 0.000), than patients in the Ropivacaine group. The pain scores during, immediately after and 30 minutes post-biopsy were lower in the Bupivacaine group: p = 0.010, p = 0.028 and p = 0.023 respectively. The time to first analgesic request was also longer in the Bupivacaine group (48.73±9.33 minutes) than for those in the Ropivacaine group (24.88±4.21 minutes) with statistical significance (p = 0.000).

Conclusion: Intraoperative analgesic properties were better in the Bupivacaine group than in the Ropivacaine group. However, home readiness was earlier in the Ropivacaine group.


Maccagnano C, Scattoni V, Roscigno M, Raber M, Angiolilli D, Montorsi F, et al. Anaesthesia in transrectal prostate biopsy: which is the most effective technique? Urol Int 2011; 87: 1-13.

Luscombe CJ, Cooke PW. Pain during prostate biopsy. The Lancet 2004; 363: 1840-1841.

Scattoni V, Zlotta A, Montironi R, Schulman C, Rigatti P, Montorsi F. Extended and saturation prostatic biopsy in the diagnosis and characterisation of prostate cancer: a critical analysis of the literature. Eur Urol 2007; 52: 1309-1322.

Chen CP, Tang SF, Hsu T-C, Tsai W-C, Liu H-P, Chen MJ, et al. Ultrasound guidance in caudal epidural needle placement. Anesthesiology 2004; 101: 181-184.

Obi A, Nnodi P. Low Dose Spinal Saddle Block Anesthesia (With 1.5 Mg Bupivacaine) For Transrectal Prostate Biopsy-Experience with 120 Cases. J Anesth Clin Res 2014; 5: 2-4. 10.4172/2155-6148.1000469

Moemen ME. Selective spinal anaesthesia. Eng J Anesth 2003; 19: 99-106.

Paria R, Surroy S, Majumder M, Paria B. Sacral Saddle Block. Indian J Anaesth 2014; 58: 80-82.

Malhotra D, Gupta SD. Review Article: Is Spinal Anaesthesia Useful in Day Surgery?. J.K. Science 2008; 10: 58-61.

Wille M. Intrathecal use of ropivacaine: a review. Acta Anaesthesiologica Belgica 2004; 55: 251-259.

Kirkwood BR, Sterne AC. Essential medical statistics. 2nd Edition. Blackwell Science Ltd, Oxford, U.K. 2003: p. 413-428.

Gautier PE, De Kock M, Van Steenberg A, Path N, Poth B, Fanart L, et al. Intrathecal Ropivacaine for Ambulatory Surgery: A Comparison Between Intrathecal Bupivacaine and Intrathecal Ropivacaine for Knee Arthroscopy. Anaesthesiology 1999; 91: 1239-1245.

Taheri S, Cogswell LP, Gent A, Strichartz GR. Hydrophobic and ionic factors in the binding of local anesthetics to the major variant of human α1-acid glycoprotein. J Pharmacol Exp Ther 2003; 304: 71-80.

Bhat SN, Himaldev MU. Comparison of efficacy and safety of ropivacaine with bupivacaine for intrathecal anesthesia for lower abdominal and lower limb surgeries. Anesth Ess Res 2013; 7: 381-387. 10.4103/0259-1162.123252

Mohta M. Ropivacaine: Is it a good choice for spinal anesthesia? J Anaesthesiol Clin Pharmacol 2015; 31: 457-460.

Malinovsky J-M, Charles F, Kick O, Lepage J-Y, Malinge M, Cozian A, et al. Intrathecal anesthesia: ropivacaine versus bupivacaine. Anesth Analg 2000; 91: 1457-1460.

Dar FA, Mushtaq MB, Khan UM. Hyperbaric spinal ropivacaine in lower limb and hip surgery: A comparison with hyperbaric bupivacaine. J Anaesthesiol Clin Pharmacol 2015; 31: 466-470.

Konda R.R.M., Anpuram LN, Chakravarthy K. A study of hyperbaric bupivacaine versus isobaric ropivacaine for elective caesarean deliveries. J Evolution Med Dent Sci 2016; 5: 2345-2448. 10.14260/jemds/2016/544

Chun D, Kil HK, Kim H, Chunghyun P, Chung K. Intrathecal meperidine reduces intraoperative shivering during transurethral prostatectomy in elderly patients. Korean J Anesthesiol 2010; 59: 389–393.

Obi AO, Okafor VU, Nnodi PI. Prospective randomised trial of spinal saddle block versus periprostatic lignocaine for anesthesia during transrectal prostate biopsy. J Urol 2011; 77: 280-285.

Kucur M, Goktas S, Kaynar M, Apiliogullari S, Kilic O, Akand M, et al. Selective Low-Dose Spinal Anesthesia for Transrectal Prostate Biopsy: A Prospective and Randomised Study. J Endourol 2015; 29: 1412-1417.

Phani AK, Chowdhury S, Das P, Ahmed FU,Kabir H, Amin R. Comparing the Incidence of Postdural Puncture Headache After Diagnostic Lumbar Puncture due to 22 Gauge Standard Versus 25 Gauge Atraumatic Needle: A Randomized Controlled Trial. Chattogram Maa-O-Shishu Hosp Med Coll J 2021; 20: 67-71.

Awad IT, Chung F. Factors affecting recovery and discharge following ambulatory surgery. Can J Anesth 2006; 53: 858-872.

Parekh SB, Parikh SS, Patel H, Mehta M. A prospective comparative observational study of clinical efficacy of isobaric ropivacaine 0.75% with isobaric bupivacaine 0.5% intrathecally in elective inguinal hernia repair surgeries. Anesth Essays Res 2017; 11: 561-566.

Singh V, Jain M, Gupta K, Rastogi B, Abrol S. Intrathecal 0.75% Isobaric Ropivacaine Versus 0.5% Heavy Bupivacaine for Elective Cesarean Delivery: A Randomized Controlled Trial. J Pioneering Med Sci 2012; 2: 75-78.

Yennawar S, Memon NY, Nandanwakar N. Comparative Study of 0.5% Bupivacaine and 0.75% Ropivacaine in Spinal Anaesthesia in Patients Undergoing Transurethral Resection of Prostate. Anals Inter Med Dent 2017; 3: 12-17.

Original Research