Pelvic Plexus Block Versus Periprostatic Nerve Block for Ultrasound-Guided Prostate Biopsy: A Meta-Analysis

Abstract

BackgroundTo relieve prostate biopsy-related pain, various local anesthetic methods have been used. The best approach was periprostatic nerve block (PNB) in the past decade. Recently, pelvic plexus block (PPB) was employed to ultrasound-guided prostate biopsy. Compared with the PNB, the PPB may block a more extensive area. Therefore, PPB may be more effective in relieving prostate biopsy-related pain. However, several prospective randomized controlled trials (RCTs) comparing PPB and PNB drew conflicting conclusions, so we compared the difference of pain control between PPB and PNB for prostate biopsy.MethodsThe following databases were retrieved up to October 2020: PubMed, Chinese biomedicine literature database, the Cochrane Library, China National Knowledge Internet databases, Wan fang databases and Google Scholar. Only the RCTs were included. The main outcome measures were Visual Analog Scale (VAS) score and complications. The literature quality and extracted data were evaluated by two authors independently. The software Review Manager (version 5.3) was used to perform the data analysis that comparing the difference of VAS score and complications between PPB and PNB.ResultsAfter screening, six articles including 336 patients from PPB group and 337 patients from PNB group were performed meta-analysis in this study. The results showed that there were no significant difference of pain control in probe insertion and local anesthetic injection between PPB and PNB, while compared with PNB, patients with PPB experienced less pain during biopsy and 30 min after biopsy, respectively(MD = −0.57, 95% CI: −1.11 to −0.03, Z = 2.06, P = 0.04; MD = −0.21, 95% CI: −0.40 to −0.02, Z = 2.15, P = 0.03). In subgroup analysis, the pooled results showed that PPB was superior to PNB in 12-cores biopsy (pooled MD = −1.16, 95% CI: −1.61 to −0.71, P < 0.00001), and more than 40-ml prostate size, regardless of transrectal or transperineal prostate biopsy. The reported major complications were urinary retention, hematuria, infection and hemospermia. The pooled results showed that there were no obvious difference in complications between PPB group and PNB group.ConclusionsOverall, this meta-analysis suggests that PPB provides safe and effective pain control of ultrasound-guided prostate biopsy, and PPB is superior to PNB. In future, it also needs more high quality, large samples RCTs to verify.

Modified Periprostatic Nerve Block Provides Better Anesthesia in Ultrasound-Guided Transperineal Prostate Biopsy

“…With the incidence rate of prostate cancer(PCa) increasing, the number of prostate biopsies(PBx) were increasing every year, PBx was the most important method for diagnosing PCa [1][2][3]. The disadvantage of TPBx was poor pain control, and most of the pain in the prostate biopsy was derived from the prostate capsule [4].How to block the pain of the structure between the skin and the prostate capsule was the key to relieve the pain of TPBx.Nash et alFirst reported in 1996 that anesthetics were injected into the area between the prostate and seminal vesicle, which could directly penetrate the neurovascular bundle and reduce the pain associated with TRUS guided prostate biopsy [5].PNB was the best anesthesia for prostate biopsy in the past decade [6][7][8][9].Further studies showed that PNB combined with perineal subcutaneous anesthesia and intra rectal lidocaine gel was a safer and more effective method for PBx local anesthesia,it could almost replace the total intravenous anesthesia [10,11]. However, the anesthetic effect of some patients receiving PNB was still poor, especially some patients with large prostate volume still could not stand the pain during biopsy [12].…”