The Feasibility of Spermatic Cord Block for Bilateral Orchiectomy in Metastatic Prostate Cancer: A Randomized Controlled Trial

Background: Prostate cancer is the second most common cancer in elderly males worldwide. Orchiectomy is one of the standard treatments, typically performed under spinal anesthesia (SA) or general anesthesia (GA). However, elderly patients often have underlying conditions, which increase perioperative cardiac risks. Spermatic cord block (SCB) is a feasible alternative, but studies comparing its pain outcomes and safety are lacking. Objective: To compare intraoperative pain scores, morphine consumption at 6- and 12-hours postoperative intervals, and postoperative complications between SA and SCB. Materials and Methods: The present study was a randomized controlled trial that included prostate cancer patients undergoing orchiectomy between June and December 2023. Patients were randomized into SA and SCB groups. Data were analyzed using the independent t-test and Fisher’s exact test. Results: Eighteen male patients were studied. In the SA group, the mean age was 73.67 years, body mass index (BMI) was 22.29 kg/m², and operative time was 30.33 minutes. In the SCB group, the mean age was 73.44 years, BMI was 21.46 kg/m², and operative time was 31.11 minutes. The mean pain scores during surgery and 1 hour postoperatively were 0 (0) and 0.33 (1) in the SA group and 0 (0) in the SCB group, with no significant difference (p=1 and 0.347, respectively). Morphine consumption at 6- and 12-hours postoperative intervals was 1.67 (1.5) and 3 (2.69) mg in the SA group, and 1.22 (0.97) and 1.33 (1.12) mg in the SCB group (p=0.466 and 0.115, respectively). No postoperative complications were observed. Conclusion: There were no significant differences in intraoperative pain scores, postoperative opioid consumption, or complications between SA and SCB. SCB appears to be a safe and effective alternative for bilateral orchiectomy in appropriately selected patients.