Perineal nerve block versus periprostatic block for patients undergoing transperineal prostate biopsy (APROPOS): a prospective, multicentre, randomised controlled study

Cai, Jian-Tong; Li, Rongbing; Wang, Shuai-Dong; Ng, Chi‐Fai; Wang, Haifeng; He, Biming; Li, Ronbing; Ren, Yan; Shi, Zhongping; Yang, Qi-Wei; Wang, Shuaidong; Zhou, Hai; Ji, Tang-Rao; Gao, Jin-Li; Chu, Shu-Guang; Huang, Fangfang; Chiu, Peter Ka‐Fung; Ka-Lun, L.O.; Chi-Fai, N.G.; Tao, Tao; Wang, Changming; Shen, Deyun; Mu, Xiangyu; Zhang, Bin; Xu, Rong-Yao; Chen, Jianrong; Chai, Jiantong; Li, Shaopeng; Lin, Zhongqin; Liu, Yu; Zhang, Yihua; Lan, Dong; Lan, Jian-Hua; Qiao, Ying; Dai, Zhulin; Yang, Lin; Luo, Yi; Lin, Qiang; Zhou, Shengcai; Han, Qipeng; Si, Shubin; Chen, Song; Liang, Hongbin; Jin, Zhi-Chao

doi:10.1016/j.eclinm.2023.101919

Cited by 5 publications

(4 citation statements)

References 27 publications

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“…In one small cohort, mean patient-reported pain with TP approach was 8.02 (out of 10) ( 16 ), which, however, may be considered a significantly outlying result. Interestingly, the recently published results of the APROPOS study demonstrate that anesthesia using perineal nerve block, instead of periprostatic block, may lead to improved pain control and patient satisfaction ( 25 ).…”

Section: Discussionmentioning

confidence: 99%

Patient-reported pain associated with grid-based transperineal magnetic resonance imaging (MRI)/ultrasound (US) software fusion biopsy of the prostate under local anesthesia: a multicenter experience

Szempliński,

Kamecki,

Mokrzyś

et al. 2023

Transl Androl Urol

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Background Biopsy by transperineal (TP) approach is recommended standard for prostate cancer (PC) diagnosis. To avoid pain, patients undergoing TP biopsy may be offered sedation or general anesthesia. Our aim was to investigate the degree of patient-reported pain for magnetic resonance imaging (MRI)/ultrasound (US) fusion biopsy of the prostate being performed under local anesthesia (LA) and to study for possible factors associated with increased risk of significant pain (SP) in this setting. Methods In this retrospective observational study, we reviewed data of consecutive patients without a prior diagnosis of PC who underwent MRI/US software fusion biopsy of the prostate under LA with lidocaine at two centers between May 2020 and April 2022, and who reported their periprocedural pain on a Wong-Baker FACES Pain Rating Scale (0–10). We defined SP as reported pain score of 6–10. Patient and procedure characteristics together with SP were studied for interdependencies. Results A total of 299 patients were included. Median pain score was 2 (interquartile range: 2–4), with SP having been reported by 55 (18.4%) patients. Among patient characteristics, only age demonstrated association with SP [odds ratio (OR), per 10 years =0.53, 95% confidence interval (CI): 0.35–0.80, P=0.003] and patients aged 62 or above were significantly less likely to report SP (OR =0.33, 95% CI: 0.18–0.60, P<0.001). Conclusions Performing TP MRI/US fusion prostate biopsy under LA is associated with low rates of SP, with the risk being significantly lower in older men. The results of this study can serve as evidence resource for preprocedural counselling in patients especially concerned about the risk of pain.

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Section: Discussionmentioning

confidence: 99%

Patient-reported pain associated with grid-based transperineal magnetic resonance imaging (MRI)/ultrasound (US) software fusion biopsy of the prostate under local anesthesia: a multicenter experience

Szempliński,

Kamecki,

Mokrzyś

et al. 2023

Transl Androl Urol

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“…The trial was registered on ClinicalTrials.gov and all participants provided written informed consent. Additional information on the APROPOS trial has been published previously 11 . The trial was conducted and reported in accordance with the protocol and the statistical analysis plan (Supplementary Appendix, Supplemental Digital Content 1, http://links.lww.com/JS9/A810 ).…”

Section: Methodsmentioning

confidence: 99%

“…To address these gaps in knowledge, we designed the APROPOS study, a multicentre and randomized controlled trial for comparing the perineal nerve block and the periprostatic block in patients undergoing transperineal prostate biopsy 10 . The primary analysis of the APROPOS study was presented previously, and clinically meaningful improvements in pain control were reported for the perineal nerve block compared with the periprostatic block 11 . In the current secondary analysis, we investigated the association of biopsy core number and location with pain outcome and obtained the following data.…”

Section: Introductionmentioning

confidence: 99%

Association of biopsy core number and location with pain in patients undergoing a transperineal prostate biopsy under local anaesthesia: A secondary analysis of the APROPOS trial

Yang

Shi

et al. 2023

International Journal of Surgery

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Background: APROPOS was a multicentre, randomized, blinded trial focus on investigating the perineal nerve block versus the periprostatic block in pain control for men undergoing a transperineal prostate biopsy. In the analysis reported here, we aimed to evaluate the association of biopsy core count and location with pain outcomes in patients undergoing a transperineal prostate biopsy under local anaesthesia. Methods: APROPOS was performed at 6 medical centres in China. Patients with suspected prostate cancer were randomized to receive either a perineal nerve block or a periprostatic block (1:1), followed by a transperineal prostate biopsy. The secondary analysis outcomes were the worst pain experienced during the prostate biopsy and post-biopsy pain at 1,6 and 24 hours. Results: Between August 12, 2020, and July 20, 2022, a total of 192 patients were randomized in the original trial, and 188 were involved in this analysis, with 94 patients per group. Participants had a median (IQR) age of 68 (63-72) and a median (IQR) prostate volume of 42.51 (30.04-62.84). The patient population had a median (IQR) number of biopsy cores of15 (12-17.50), and 26.06% of patients had a biopsy cores count of more than 15. After adjusting tthe baseline characteristics, the number of biopsy cores was associated with the worst pain during the biopsy procedure in both the perineal nerve block group (Beta 0.19, 95% CI 0.12-0.26, P<0.001) and the periprostatic block group (beta 0.16, 95% CI 0.07-0.24, P<0.001). A similar association was also evident for the post-biopsy pain at 1, 6 and 24 hours. A lesser degree of pain in both groups at any time (r range −0.57 to −0.01 for both groups) was associated with biopsy cores from the peripheral zone of the middle gland, while other locations were associated with a higher degree of pain. In addition, the location of the biopsy core had less of an effect on pain during the biopsy (r range −0.01 to 0.25 for both groups) than it did on postbiopsy pain (r range −0.57 to 0.60 for both groups). Conclusions: In this secondary analysis of a randomized trial, biopsy core count and location were associated with pain in patients undergoing a transperineal prostate biopsy under local anaesthesia. These results may be helpful for making clinical decisions about the anaesthetic approach forscheduled transperineal prostate biopsies.

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“… 47 A recent multicenter study has shown that perineal nerve blocks are more effective than the commonly used periprostatic block for TR biopsy. 49 Complications of pudendal block include nerve damage, bladder or rectal injury, and intravascular injection after pudendal artery puncture, which can be fatal. 46…”

Section: Transperineal Biopsymentioning

confidence: 99%

Shifting to transperineal prostate biopsy: A narrative review

Chung,

Hong

2023

Prostate International

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Perineal nerve block versus periprostatic block for patients undergoing transperineal prostate biopsy (APROPOS): a prospective, multicentre, randomised controlled study

Cited by 5 publications

References 27 publications

Patient-reported pain associated with grid-based transperineal magnetic resonance imaging (MRI)/ultrasound (US) software fusion biopsy of the prostate under local anesthesia: a multicenter experience

Patient-reported pain associated with grid-based transperineal magnetic resonance imaging (MRI)/ultrasound (US) software fusion biopsy of the prostate under local anesthesia: a multicenter experience

Association of biopsy core number and location with pain in patients undergoing a transperineal prostate biopsy under local anaesthesia: A secondary analysis of the APROPOS trial

Shifting to transperineal prostate biopsy: A narrative review

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