Is the periprostatic anesthetic blockade advantageous in ultrasound-guided prostate biopsy?

Vanni, André P; Schaal, Carlos H; Costa, Renato Prado; Sala, F.

doi:10.1590/s1677-55382004000200005

Cited by 17 publications

(10 citation statements)

References 16 publications

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“…1). After screening 46 RCTs15678910111213141516171819202122232425262728293031323334353637383940414243444546474849 met our study criteria and were included in our meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

Local anesthesia for transrectal ultrasound-guided biopsy of the prostate: A meta-analysis

Wang

et al. 2017

Sci Rep

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A meta-analysis was performed to evaluate the efficacy of local anesthesia in alleviating pain during prostate biopsy. We searched relevant articles in PubMed and Embase. The included studies should be randomized controlled trials (RCT) using local anesthesia to alleviate pain during biopsy, which was recorded by a pain scale. Analgesic efficacy of different local anesthesia techniques were analyzed, including intrarectal local anesthesia (IRLA), periprostatic nerve block (PNB), pelvic plexus block (PPB) and intraprostatic local anesthesia (IPLA). We included 46 RCTs. PNB significantly reduced pain score compared with placebo (−1.27 [95% confidence interval [95% CI] −1.72, −0.82]) or no injection (−1.01 [95% CI −1.2, −0.82]). IRLA with prilocaine-lidocaine cream could also reduced pain (−0.45 [95% CI −0.76, −0.15]), while the IRLA with lidocaine gel was not effective (−0.1 [95% CI −0.24, 0.04]). PNB lateral to the neurovascular bundle had better analgesic effect than at prostate apex (P = 0.02). Combination use of PPB and IRLA considerably alleviated pain of patients compared with the combination of PNB and IRLA (−1.32 [95% CI −1.59, −1.06]). In conclusion, local anesthesia could alleviate patients’ pain during the prostate biopsy. PNB was not so effective as PPB.

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“…1). After screening 46 RCTs15678910111213141516171819202122232425262728293031323334353637383940414243444546474849 met our study criteria and were included in our meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

Local anesthesia for transrectal ultrasound-guided biopsy of the prostate: A meta-analysis

Wang

et al. 2017

Sci Rep

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“…No significant difference in hematuria and hematochezia between LA and CT. Mallick [43] No difference (LA vs. CT) in hematuria (2% vs. 2%), hematospermia (1% vs. 1%). Vanni [55] No difference in hematuria and rectal bleeding between LA & CT. Nambirajan [44] No significant difference in hematuria (8.4% vs. 10.4%), rectal bleeding (8.4% vs. 6.3%), hematospermia (18.8% vs. 23%) and infection (8.3% vs. 10.4%) between groups (LA vs. CT). Obek [45] Higher rate of complications in periprostatic infiltration but not significantly different.…”

Section: Intrarectal Lignocainementioning

confidence: 90%

“…[34][35][36]42,44,[51][52][53]19,56 They were not specified in the remaining 15 trials. 14,[37][38][39][40][41]43,[45][46][47][48][49][50]54,55 For the trials assessing the efficacy of PPNBs, two types of controls were used. Either no anesthesia at all was given or an equivalent volume of normal saline injection was administered.…”

Section: Study Description and Validitymentioning

confidence: 99%

“…Trials that used placebo injections as controls were double-blinded, whereas trials that used no anesthesia as controls had no concealment of treatment allocation. For the 10 trials with placebo injections, concealment of allocation was judged to be adequate with central office randomization in six studies, 35,42,46,55,19,56 but was not used or unclear in the remaining four. 14,40,47,48 For these 10 studies, there was also concern that normal saline placebo injections may cause additional injection-related pain 41 and pain scores from placebo injections alone had been measured to be between 1.1 and 1.8.…”

Section: Study Description and Validitymentioning

confidence: 99%

“…19 Combined local anesthetic injections to both the prostate base and apex have subsequently been studied but have not been shown to be significantly more effective than either technique on its own. 46,51 However, when local anesthestic injections were given too laterally, either targeted lateral to the tip of seminal vesicles 56 or lateral to the prostate on its transversal images, 55 pain relief is ineffective and these techniques had been criticized to be too far from the neurovascular bundle. 58 Data from this meta-analysis has demonstrated that PPNB reduces pain significantly for patients undergoing between six to 12 biopsies.…”

Section: Periprostatic Nerve Blockmentioning

confidence: 99%

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A meta-analysis of local anesthesia for transrectal ultrasound-guided biopsy of the prostate

Tiong

Liew

Samuel

et al. 2007

Prostate Cancer Prostatic Dis

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This meta-analysis evaluated the efficacy and safety of periprostatic nerve block (PPNB) and intrarectal local anesthestic (IRLA) gel in alleviating pain during prostate biopsy. Electronic databases MEDLINE, Cochrane Central Register of Controlled Trials and EMBASE were searched to identify all randomized controlled trials comparing PPNB with periprostatic placebo injection, no injection or with IRLA. Studies for inclusion were identified and extracted by two authors independently. The main outcome measure was patients' assessment of mean pain scores on a 10-point scale at the end of the biopsy procedure. Secondary outcomes were complications and adverse events. Continuous data from the trials were combined by calculating the weighted mean difference (WMD) with its 95% confidence interval. In total, 25 studies met the inclusion criteria. Twenty studies involving 1685 patients compared PPNB with either no anesthesia or with placebo injection controls, showing a significant reduction in pain score in the anesthetic group (WMD À2.09, 95% CI À2.44 to À1.75, Po0.00001). Five studies with 466 patients compared IRLA and control. Although IRLA was associated with pain reduction, the effect size was not statistically significant (WMD À0.22, 95% CI À0.56 to 0.12). Six studies with 872 patients compared PPNB with IRLA, showing a significant pain reduction in the former group (WMD À1.53, 95% CI À2.67 to À0.39, P ¼ 0.008). No trials reported an increase in complications in the treatment arms. In conclusion, the evidence from randomized controlled trials shows that local anesthetic given as a PPNB, but not as an intrarectal instillation, is effective and safe in alleviating pain from transrectal ultrasound biopsy of the prostate.

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Application of Prostate Ultrasound for Prostate Biopsy

Porter

Pham

2014

Prostate Ultrasound

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Is the periprostatic anesthetic blockade advantageous in ultrasound-guided prostate biopsy?

Abstract: The lidocaine injection did not show statistical difference when compared with saline solution in the periprostatic blockade during echo-guided prostate biopsy.

Cited by 17 publications

References 16 publications

Local anesthesia for transrectal ultrasound-guided biopsy of the prostate: A meta-analysis

Local anesthesia for transrectal ultrasound-guided biopsy of the prostate: A meta-analysis

A meta-analysis of local anesthesia for transrectal ultrasound-guided biopsy of the prostate

Application of Prostate Ultrasound for Prostate Biopsy

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