Abstract
We evaluated whether pelvic plexus block (PPB) is superior to periprostatic nerve block (PNB) for pain control during transrectal ultrasonography (TRUS)-guided prostate biopsy (PBx). A prospective, double-blind, randomized, controlled study was performed at a single center; 46 patients were enrolled and randomly allocated into two groups: PPB (n = 23) and PNB (n = 23). The visual analogue scale (VAS) was used; pain scores were measured four times: during local anesthesia, probe insertion, sampling procedures, and at 15 min post procedures. No significant differences were observed in VAS scores during local anesthesia (2.30 for PPB vs. 2.65 for PNB, p = 0.537) or during probe insertion (2.83 for PPB vs. 2.39 for PNB, p = 0.569). Similarly, no differences in VAS scores were detected during the sampling procedures (2.83 for PPB vs. 2.87 for PNB, p = 0.867) and at 15 min post procedures (1.39 for PPB vs. 1.26 for PNB, p = 0.631). No major complications were noted in either group. Both PPB and PNB are comparably effective and safe methods for PBx related pain relief, and PPB is not superior to PNB. Local anesthetic method could be selected based on the preference and skill of the operator.
Highlights
Prostate cancer (PCa) is the most frequently occurring malignancy in men worldwide, with approximately 1.1 million new cases diagnosed each year [1]
During periprostatic nerve block (PNB), the most commonly used method, lidocaine is injected into the bilateral junctions between the bladder, prostate, and seminal vesicle, with the intent to block the posterolateral neurovascular bundle that is responsible for supplying the main nerve to the prostate [5,6,7,8,9,10]
Patients with an abnormal prostate finding during digital rectal examination (DRE), a serum prostate-specific antigen (PSA) level >2.5 ng/mL, and/or an abnormal lesion detected with Transrectal ultrasonography (TRUS) were included in this study
Summary
Prostate cancer (PCa) is the most frequently occurring malignancy in men worldwide, with approximately 1.1 million new cases diagnosed each year [1]. Transrectal ultrasonography (TRUS)-guided prostate biopsy (PBx) is the gold standard for detection of PCa. The current standard PBx, using 10–14 biopsy cores, detects PCa in about 44% of patients, and it is estimated that 2.5 million procedures are performed each year worldwide [2]. Various local anesthetic methods have been developed to reduce PBx-related pain. These involve multiple types of anesthetic agents and sites of injection, and when used either alone or in combination, most were found to be effective for control of PBx-related pain [4]. During periprostatic nerve block (PNB), the most commonly used method, lidocaine is injected into the bilateral junctions between the bladder, prostate, and seminal vesicle, with the intent to block the posterolateral neurovascular bundle that is responsible for supplying the main nerve to the prostate [5,6,7,8,9,10]
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