Local anesthesia for pain control during transrectal ultrasound-guided prostate biopsy: a systematic review and meta-analysis

Abstract

BackgroundA meta-analysis was performed to evaluate the efficacy and safety of intrarectal local anesthestic (IRLA), periprostatic nerve block (PPNB), and the combined modalities in alleviating the pain during transrectal ultrasound (TRUS)-guided prostate biopsy.Materials and methodsA literature review was performed to identify all published randomized controlled trials (RCTs) about IRLA vs no anesthesia or placebo gel; PPNB vs no injection, periprostatic placebo injection, or IRLA; combined PPNB and IRLA vs PPNB alone; and combined PPNB and intraprostatic nerve block (IPNB) vs PPNB alone before TRUS-guided biopsy. Sources included MEDILINE, EMBASE, and Cochrane Library from 1980 to 2016. The main outcomes were biopsy pain score, probe manipulation pain score, and anesthetic infiltration pain score assessed by the visual pain scale.ResultsA total of 26 articles involving 36 RCTs were used in this analysis: Although IRLA can lead to pain reduction, the result was not statistically significant when compared with no anesthesia or placebo gel (weighted mean difference [WMD]: −0.22, 95% CI: −0.45 to 0, P=0.06). PPNB can lead to significantly lower biopsy pain scores when compared with no analgesia (WMD: −1.32, 95% CI: −1.68 to −0.95, P<0.00001), placebo injection (WMD: −2.62, 95% CI: −3.16 to −2.07, P<0.00001), or IRLA (WMD: −1.31, 95% CI: −1.40 to −1.22, P<0.00001). PPNB + IRLA can lead to significantly lower biopsy pain scores when compared with PPNB alone (WMD: −0.45, 95% CI: −0.62 to −0.28, P<0.00001). PPNB + IPNB can lead to significantly lower biopsy pain scores when compared with PPNB alone (WMD: −0.73, 95% CI: −0.92 to −0.55, P<0.00001). There were no severe reported general or local complications related to local anesthesia.ConclusionThis meta-analysis indicates that a combination of PPNB and IRLA/IPNB is effective and safe in alleviating the pain during TRUS-guided prostate biopsy. Further high-quality RCTs are needed to validate this result.

Comparison of pain levels in fusion prostate biopsy and standard TRUS-Guided biopsy

“…In both groups, the most painful step revealed to be the insertion of the probe into the rectum. A recent systematic review revealed that the administra-tion of intrarectal anesthetic gel followed by PNB led to a lower degree of pain both during probe movements and needle piercing but had no remarkable effect on the pain experienced during the insertion of the probe (17). Urabe et al compared the effectivity of intrarectal local anesthetic, PNB, and the combined methods in alleviating the pain during TRUS-guided SPB and reported that PNB led to lower pain levels during the insertion of the probe compared to other techniques (18).…”

Comparison of Lidocaine and Prilocaine Efficiencies in Periprostatic Nerve Block for Transrectal Prostate Biopsy: A Randomized Prospective Study

“…Comparison of PPNB and PPNB + IRLA showed that probe manipulations were less painful in patients who received PPNB alone, while the PPNB + IRLA group experienced less pain when the needle contacted the prostate (16). When the patients in our study were asked which stage of the procedure was most painful, they said it was insertion of the rectal probe ( Figure 1).…”

“…According to the findings of Alavi et al (15), PPNB with lidocaine was more advantageous compared with IRLA alone. In a meta-analysis comparing PPNB and IRLA with their combination, it was reported that the combination was more effective at controlling pain compared to IRLA or PPNB alone (16). There are numerous studies demonstrating that PPNB is effective in pain control during TRUS-guided prostate biopsy (17,18).…”

Is Pelvic Plexus Block Superior to Periprostatic Nerve Block for Pain Control during Transrectal Ultrasonography-Guided Prostate Biopsy? A Double-Blind, Randomized Controlled Trial

“…The current standard PBx, using 10–14 biopsy cores, detects PCa in about 44% of patients, and it is estimated that 2.5 million procedures are performed each year worldwide [2]. Notably, patients undergoing PBx are under considerable psychological stress due to the potential for a cancer diagnosis, fear of anal penetration, and the pain induced by both probe insertion and core biopsy [3].…”