The effectivity of periprostatic nerve blockade for the pain control during transrectal ultrasound guided prostate biopsy

Abstract

Aim: Transrectal ultrasound (TRUS) guided prostete biopsy is accepted as a standard procedure in the diagnosis of prostate cancer. Many different protocoles are applied to reduce the pain during the process. In this study we aimed to the comparison of two procedure with intrarectal lidocaine gel and periprostatice nerve blockade respective- ly in addition to perianal intrarectal lidocaine gel on the pain control in prostate biop- sy by TRUS. Methods: 473 patients who underwent prostate biopsy guided TRUS between 2008-2012 were included in the study. 10-point linear visual analog pain scale(VAS) was used to evaluate the pain during biopsy. The patients were divided into two groups according to anesthesia procedure. In Group 1, there were 159 patients who had perianal-intrarectal lidocaine gel, in Group 2 there were 314 patients who had periprostatic nerve blockade in addition to intrarectal lidocain gel. The pain about probe manipulation was aseesed by VAS-1 and during the biopsy needle entries was evalu- ated by VAS-2. Results were compared with Mann-Whitney U and Pearson chi-square test. Results: Mean VAS-2 scores in Group 1 and Group 2 were 4.54 ± 1.02 and 2.06 ± 0.79 respectively. The pain score was determined significantly lower in the Group 2 (p = 0.001). In both groups there was no significant difference in VAS-1 scores, patient’s age, prostate volume, complication rate and PSA level. Conclusion: The combination of periprostatic nerve blockade and intrarectal lidocain gel provides a more meaningful pain relief compared to group of patients undergoing intrarectal lidocaine gel.

Transrectal ultrasonography (TRUS)‐guided pelvic plexus block to reduce pain during prostate biopsy: a randomised controlled trial

“…Currently, PNB is considered to be the state‐of‐the‐art for pain control during prostate biopsy. There are many papers that have reported its effectiveness . Recently, other techniques have challenged conventional PNB; nerve blocks such as intraprostatic nerve block and PPB have been described and are reported to be very effective .…”

“…In PNB, lignocaine injection is instilled bilaterally at the junction between the bladder, prostate and seminal vesicle with the intention to block the posterolateral neurovascular bundle carrying the main nerve supply to prostate . However, there are a few superolateral and anterior fibres that escape.…”

“…A). In group‐2 with PNB, injection was given on each side into the neurovascular bundles at the prostate‐bladder‐seminal vesicle junction as described in the literature (Fig. B).…”

“…Local application of lignocaine gel is a common method used for pain alleviation during prostate biopsy but there is doubt over its clinical efficacy . Currently, periprostatic nerve block (PNB) is considered to be the ‘gold standard’ for decreasing the pain from the insertion of the biopsy needle into the prostatic tissue . Again, this method has not been found to be totally satisfactory and research continues for a better method.…”

Diclofenac Suppository as a Preemptive Analgesia in Ultrasound-guided Biopsy of Prostate: Randomized Controlled Trial

“…However, its position as the current gold standard is being challenged by many recent publications indicating additional analgesia provides better pain control than nerve block alone. The combination of periprostatic nerve blockade and intrarectal lidocain gel provides a more meaningful pain relief compared to group of patients undergoing intrarectal lidocaine gel 4 . Recently it has been noted that additional use of lidocaie-prilocaine jel in addition to peri prostatic nerve block provides better analgesia in a randomized controlled trail 5 .…”