Periprostatic nerve block alone versus combined with perineal pudendal nerve block or intrarectal local anesthesia during transrectal ultrasound‐guided prostate biopsy: A prospective randomized controlled trial

Abstract

Objectives To compare the efficacy, safety and cost of combinations of perineal pudendal nerve block + periprostatic nerve block and intrarectal local anesthesia + periprostatic nerve block with the standard technique (periprostatic nerve block). Methods The study was designed as a randomized prospective controlled trial. Patients with elevated serum prostate‐specific antigen values (prostate‐specific antigen ≥4 ng/mL) and/or abnormal digital rectal examination findings were included in the study. Patients with anorectal diseases, chronic prostatitis, previous history of prostate biopsy and anorectal surgery were excluded from the study. A total of 148 patients (group 1 [periprostatic nerve block], n = 48; group 2 [intrarectal local anesthesia + periprostatic nerve block], n = 51; group 3 [perineal pudendal nerve block + periprostatic nerve block], n = 49) were included in the final analysis. Pain during insertion and manipulation of the transrectal ultrasound probe was recorded as visual analog scale 1, pain during penetration of the biopsy needle into the prostate and sampling was recorded as visual analog scale 2, and pain during the entire procedure recorded as visual analog scale 3. Results The mean visual analog scale 1 score was significantly lower in group 3, when compared with group 1 and group 2 (P < 0.001). There was no significant difference between the groups in terms of the mean visual analog scale 2 score. The mean visual analog scale 3 score was significantly lower in group 3 when compared with other groups (P < 0.001). The total cost for transrectal ultrasound‐guided biopsy in the intrarectal local anesthesia + periprostatic nerve block group was significantly higher than the other two groups. Conclusions The combination of perineal pudendal nerve block and periprostatic nerve block provides more effective pain control than intrarectal local anesthesia plus periprostatic nerve block and periprostatic nerve block alone, with similar complication rates and without increasing cost.

Wavelet Transform-Based Ultrasound Image Enhancement Algorithm for Guided Gynecological Laparoscopy Imaging of Local Anesthetics in Perioperative Gynecological Laparoscopy

“…Previous studies have pointed out that local anesthetics combined with nerve block can reduce the dosage of opioid analgesics [13]. e results showed that the VAS scores and PONV scores of patients with TAP block decreased evidently at 3 h, 6 h, and 12 h after surgery, and the number of patients who used tramadol for analgesic remedy after surgery was reduced, which greatly improved patient satisfaction.…”

Pudendal Nerve Block in Hemorrhoid Surgery: A Systematic Review and Meta-analysis

“…47 Even PNB may not fully cover the whole duration of postoperative pain, which usually lasts 7 to 10 days after hemorrhoidectomy, but it facilitates same-day patient discharge and assumedly decreases health care costs. 35,39,44,48,49 Complications related to the PNB procedure such as intravenous injection of the anesthetic, permanent nerve lesions, hematoma, abscesses or phlegmons were never reported in our literature search, 14,40,44,50 have been subject to reporting bias. Pudendal nerve block obviously requires adequate training and expertise.…”

“…47 Even PNB may not fully cover the whole duration of postoperative pain, which usually lasts 7 to 10 days after hemorrhoidectomy, but it facilitates same-day patient discharge and assumedly decreases health care costs. 35,39,44,48,49…”