Abstract
BackgroundWe identified pain variation according to prostate biopsy sites and compared differences in pain relief according to the site of periprostatic nerve block (PNB).MethodsThis retrospective study collected data from 312 patients who underwent transrectal prostate biopsies between January 2019 and August 2020. Patients were stratified into two groups according to the site of local anesthesia (base vs. base and apex PNB), with each block achieved with 2.5 cm3 of 2% lidocaine. Pain scores were assessed using the visual analog scale at the following time points: probe insertion, PNB at base, PNB at apex, each of the 12 core biopsy sites, and 15 min after biopsy. The results were analyzed using a linear mixed model.ResultsThe average pain scores were significantly higher in the base-only PNB group than were those in the base and apex PNB group (3.88 vs 2.82, p < 0.001). In the base-only PNB group, the pain scores increased from base to apex (p < 0.001), and the pain at each site also gradually increased as the biopsy proceeded (p < 0.001). In contrast, in the base and apex PNB group, there was minor change in pain scores throughout the procedure.ConclusionsThe pain scores varied at each site during the prostate biopsy. The provision of a base and apex PNB provided greater pain relief than does base-only PNB during prostate biopsy.
Highlights
We identified pain variation according to prostate biopsy sites and compared differences in pain relief according to the site of periprostatic nerve block (PNB)
As the experience of pain during prostate biopsy lowers patient compliance, this procedure should be performed under local anesthesia, in accordance with the guidelines provided by the National Comprehensive Cancer Network (NCCN)
Data are expressed as number (%), mean ± standard deviation, and median (IQR range) AUR, acute urinary retention; digital rectal examination (DRE), digital rectal exam; IQR, interquartile; PNB, periprostatic nerve block; prostate-specific antigen (PSA), prostate specific antigen; VAS, visual analog scale the base-only PNB group and the base and apex PNB group
Summary
We identified pain variation according to prostate biopsy sites and compared differences in pain relief according to the site of periprostatic nerve block (PNB). Systematic random prostate biopsy is generally performed via a transrectal or transperineal approach for the diagnosis of prostate cancer [1, 2]. The transrectal ultrasound (TRUS)-guided random prostate biopsy may cause severe pain, hematuria, urinary retention, infection, and even septic shock [3,4,5]. As the experience of pain during prostate biopsy lowers patient compliance, this procedure should be performed under local anesthesia, in accordance with the guidelines provided by the National Comprehensive Cancer Network (NCCN). Active pain relief was not previously adopted; for pain relief, general anesthesia, intrarectal local anesthesia, pudendal and caudal nerve block, periprostatic local anesthesia, intravenous conscious sedation (propofol, midazolam), and intravenous analgesics (fentanyl) have been attempted [6]. Intrarectal lidocaine gel (IRLG), pelvic plexus block (PPB), and periprostatic nerve block (PNB) using prilocaine or lidocaine are generally used in the clinical setting [7,8,9,10,11]
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