Periprostatic Nerve Block Group Research Articles

Comparison of intrarectal heated lidocaine gel and periprostatic nerve block for pain control in transrectal ultrasound-guided prostate biopsy: A randomized controlled non-inferiority trial.

To investigate whether intrarectal local anesthesia with heated lidocaine gel (IRLAH) is non-inferior to periprostatic nerve block (PNB) for reducing pain in patients undergoing transrectal ultrasound (TRUS)-guided prostate biopsy. We performed a randomized controlled non-inferiority trial with 100 participants who underwent systematic TRUS-guided, 12-core prostate biopsy from August 2019 to July 2020. These participants were randomly assigned to a group receiving intrarectal local anesthesia with 20mL of heated (40°C) 2% lidocaine gel (n=50) or PNB (n=50). The primary outcome was a pain score on a 0-10 visual analogue scale (VAS) at four time points with the non-inferiority margin of 1; VAS-1: during local anesthesia application; VAS-2: during probe insertion; VAS-3: during biopsy; VAS-4: 30minutes after the procedure. The secondary outcome included complications during and after the procedure. The IRLAH group (0.1) met non-inferiority as well as superiority criteria for mean VAS-1 score vs. the PNB group (2.33) (P<0.001), as the difference (95% confidence interval [CI]) between the two groups was-2.23 (-2.66 to-1.79) and the upper bound of the 95% CI were both below the prespecified non-inferiority margin and below zero. For mean VAS-3 score, the difference (95% CI) was 0.3 (-0.38 to 0.98) and the upper bound of the 95% CI did not exceed the predefined non-inferiority margin indicating that IRLAH was non-inferior (IRLAH group, 3.44; PNB group, 3.14). Also, non-inferiority was shown for pain scores at VAS-2 and VAS-4. There were no significant differences in complications. IRLAH is a noninvasive and non-inferior alternative to PNB for pain control in TRUS-guided prostate biopsy without increased risk of complications.

Pain control according to the periprostatic nerve block site in magnetic resonance imaging/transrectal targeted prostate biopsy

We analyzed the intensity of pain at each site of systemic prostate biopsy (SBx) and compared the intensity of pain among magnetic resonance (MRI)-targeted transrectal biopsies according to the periprostatic nerve block (PNB) site. We collected data from 229 consecutive patients who had undergone MRI-targeted biopsy. Patients were stratified into two groups according to the site of PNB (base versus base and apex PNB). Pain was quantified at the following time points: probe insertion, injection at the prostate base, injection at the prostate apex, MRI cognitive biopsy (CBx), MRI/transrectal ultrasound fusion biopsy (FBx), SBx, and 15 min after biopsy. For all biopsy methods, the average pain were significantly higher in the base PNB group than in the base and apex PNB group (CBx, p < 0.001; FBx, p = 0.015; SBx, p < 0.001). In the base and apex PNB group, FBx was significantly more painful than SBx (p = 0.024). Overall, regardless of the PNB site, pain at the anterior sites was more than that at the posterior sites in FBx (p = 0.039). Base and apex PNB provided better overall pain control than base-only PNB in all biopsy methods. In the base and apex PNB group, FBx was more painful than CBx and SBx.

Efficacy of additional periprostatic apex nerve block on pain in each of 12 transrectal prostate core biopsies: a retrospective study

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.

Comparison of the tolerability and efficacy of intra-rectal lidocaine gel with peri-prostatic nerve block as anaesthetic techniques for prostate biopsy

BackgroundProstate biopsy is a painful procedure. However, over the years, varied opinions exist among urologists about the methods of achieving optimal pain relief for the procedure. The purpose of this study was to compare the tolerability of administration and the efficacy of intra-rectal lidocaine gel with peri-prostatic nerve block for this procedure.MethodsFrom June 2016 to June 2017, 110 patients who met the study criteria were randomized to receive either intra-rectal lidocaine gel (Group 1) or an apical peri-prostatic nerve block (Group 2) for prostate biopsy. Their level of pain perception during the anaesthesia administration and the prostate biopsy was assessed using the Numeric Rating Scale. Other biopsy-related complications and patient satisfaction were also evaluated. Grouped data were compared using student t test and Chi-square with p < 0.05 considered significant.ResultsThe pain score during the administration of anaesthesia was 1.6 ± 1.9 and 3.7 ± 2.1 for the intra-rectal lidocaine gel and peri-prostatic nerve block groups, respectively (p = 0.001). However, during the prostate biopsy, the pain score was 6.8 ± 2.2 and 2.9 ± 1.9 for the intra-rectal lidocaine gel and peri-prostatic nerve block groups, respectively (p = 0.001). There was a significantly lower rate of satisfaction (45.3% versus 86.8%, p = 0.001) in the lidocaine gel group.ConclusionsAlthough intra-rectal lidocaine gel administration is better tolerated by patients, a peri-prostatic nerve block is more effective and provides better patient satisfaction than intra-rectal lidocaine gel when used as anaesthesia for prostate biopsy.

Comparative evaluation of bilateral pudendal nerve blockade and periprostatic nerve block in transrectal ultrasound guided prostate biopsy: a prospective randomised trial.

IntroductionAlthough the periprostatic nerve block (PNB) is accepted as the standard method for local anesthesia prior to transrectal ultrasound (TRUS)-guided prostate biopsy, it is not the most ideal method. We aimed to analyze the effectiveness and safety of bilateral pudendal nerve blockage (PuNB) by comparing with PNB.Material and methodsBetween June 2019 and October 2019, a total of 108 patients with elevated serum prostate specific antigen values (PSA ≥4 ng/ml) and/or abnormal digital rectal examination findings were included in the study. After exclusion criteria, the remaining 91 patients were randomly divided into two groups as PuNB (n = 46) and PNB (n = 45). Pain during local anesthesia application was recorded as a visual analog scale (VAS) 1, pain during placement of the rectal probe and manipulation was recorded as VAS 2 and pain during needle penetration into prostate tissue and sampling was recorded as VAS 3.ResultsNo significant difference was found between the two groups with regard to age, body mass index, serum PSA, prostate volume and prostate cancer rates. Mean VAS-2 score was significantly lower in the PuNB group when compared with the PNB group. There was no significant difference in terms of VAS-1 and VAS-3 scores. There was no significant difference between the groups in terms of mild and severe complications.ConclusionsBoth techniques are safe for TRUS-guided prostate biopsy; however, PuNB provided more effective pain control compared to PNB especially during placement of rectal probe and manipulation.

The Efficiency and Safety of Intrarectal Topical Anesthesia for Transrectal Ultrasound-Guided Prostate Biopsy: A Systematic Review and Meta-Analysis

Objective: The study aims to review the current evidence to determine the efficiency and safety of intrarectal topical anesthesia (ITA) for transrectal ultrasound-guided prostate biopsy. Materials and Methods: A comprehensive search of the literature was performed using Medline, Embase and Cochrane central register of controlled trials. All randomized controlled trials (RCTs) comparing the efficacy and safety of periprostatic nerve block (PNB), ITA, and PNB combined with ITA were included. The mean pain scores after the biopsy procedure, the mean pain scores after the probe insertion and adverse events were evaluated. Results: Thirty-2 RCTs were identified in the meta-analysis. ITA could significantly reduce pain during probe insertion compared to control and placebo. The PNB group had less pain after the prostate biopsy than the ITA group. PNB combined with ITA could significantly reduce pain during the biopsy procedure compared to ITA alone. No significant differences were found in adverse events in ITA versus control, ITA versus placebo, and ITA versus PNB. Conclusions: ITA could reduce pain after probe insertion and pain after biopsy although it was inferior to PNB in reducing pain during prostate biopsy. ITA combined with PNB was more effective than ITA alone. In addition, it was safe to perform ITA for prostate biopsy.

Prospective comparison of the efficacy of caudal versus periprostatic nerve block, both with intrarectal local anesthesia, during transrectal ultrasonography-guided prostatic needle biopsy

Objective: The aim of this study was to compare the effectiveness of caudal block (CB) versus periprostatic nerve block (PPNB), both with intrarectal local anesthesia (IRLA), in reducing pain during transrectal ultrasonography (TRUS)-guided prostatic biopsy.Materials and methods: This study included 532 patients: 266 patients received CB with IRLA and 266 patients PPNB with IRLA. A visual analogue scale (VAS) was applied to prospectively evaluate pain (1) at induction of anesthesia, (2) at insertion of the TRUS probe, (3) at needle penetration to the prostate, and (4) throughout the biopsy procedure. Pain scores were compared to evaluate differences between groups. The secondary endpoint of serious complication rate was also evaluated. As a subanalysis, the pain scores were compared in patients with high body mass index (BMI ≥25 kg/m²).Results: Overall, the pain score in the PPNB group was significantly lower than in the CB group at induction of anesthesia (mean ± SD: 2.0 ± 1.9 vs 2.9 ± 2.1, p = .0001) but higher at insertion of the TRUS probe (2.7 ± 2.5 vs 1.9 ± 1.7, p = .009). The pain score did not differ significantly between groups at needle penetration or throughout the biopsy. Univariate analyses indicated no significant association between VAS scores and patient demographics. Overall rates of serious complications did not differ between the two groups (5.6% vs 5.3%, p = .85). In patients with high BMI, the pain score was significantly lower in the PPNB group than in the CB group throughout the procedure (2.5 ± 2.0 vs 3.5 ± 2.5, p = .03).Conclusions: Both procedures were equally effective in reducing pain, and the incidence of serious complications was similar. PPNB with IRLA may be more applicable than CB with IRLA in obese patients.

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

To assess the role of pelvic plexus block (PPB) in reducing pain during transrectal ultrasonography(TRUS)-guided prostate biopsy, compared with the conventional periprostatic nerve block (PNB). A prospective, double-blind observational study was conducted with patients being randomised into three groups. Group-1 (47 patients) received intrarectal local anaesthesia (IRLA) with 10 mL 2% lignocaine jelly along with pelvic plexus block (PPB) with 2.5 mL 2% lignocaine injection bilaterally. Group-2 (46 patients) received IRLA with periprostatic nerve block (PNB). Group-3 (46 patients) received only IRLA without any type of nerve block. The patients were requested to rate the level of pain from 0 to 10 on a visual analogue scale (VAS) at two time points: VAS-1: during biopsy procedure and VAS-2: 30 min after the procedure. The mean age of the patients, mean volume of the prostates and mean serum PSA values were comparable among the three groups. The mean pain score during biopsy was significantly less in the PPB group [mean (range) sore of 2.91 (2-4)] compared with the PNB group [mean (range) score of 4 (3-5)], and both these groups were superior to the no nerve block group [mean score of 5.4 (3-7)]. There was no significant difference between the mean pain scores, 30 min after the procedure among the three groups with the mean (range) scores being 2.75 (2-4), 2.83 (2-4) and 2.85 (2-4), respectively. PPB is superior to conventional periprostatic nerve block (PNB) for pain control during TRUS-guided biopsy and both are in turn superior to no nerve block.

Procedural sedation and analgesia as an adjunct to periprostatic nerve block for prostate biopsy: A prospective randomized trial.

To assess whether patient comfort could be increased by adding procedural sedation and analgesia (PSAA) to periprostatic nerve block (PNB) in patients undergoing transrectal ultrasound-guided prostatic biopsy (TRUS-PB). This was a prospective, randomized (1:2) trial comparing PNB with the combination of PSAA+PNB in patients undergoing TRUS-PB. PNB was achieved by using lidocaine gel and lidocaine and bipuvacaine infiltration. PSAA-treated patients received midazolam and remifentanil. All biopsies were standardized and performed in a fully equipped endourology suite. PSAA was delivered by an anesthesiology nurse in the presence and availability of an anesthesiologist. An orally administered numeric scale of 0-10 was used to assess the patient's pain, and a visual scale of 0-4 was used to quantify their satisfaction. Pain and satisfaction scores were compared between the groups. Data on 331 patients were analyzed: 235 received PNB, and 96 received PSAA+PNB. Distribution within the groups by age, prostate-specific antigen serum levels, prostate volume, and number of cores obtained was similar. Airway insertion was required in 4 of 96 patients in PSAA+PNB arm (4%), with no other complications related to sedation. The average pain level was significantly lower in the PSAA+PNB group than it was in the PNB group (0.88 versus 1.31; p = 0.008). The satisfaction level was high (3.5) and alike in the two groups; however, significantly more patients reported a perfect score of 4 in the PSAA+PNB arm (p = 0.03). PSAA with midazolam and remifentanil used as an adjunct to the standard PNB is safe and effective during TRUS-PB. Patients undergoing PSAA in addition to PNB experienced significantly less pain and higher satisfaction scores than did those given PNB alone.

2062 A SYSTEMATIC REVIEW AND META-ANALYSIS COMPARING THREE METHODS OF ANESTHESIA FOR TRANSRECTAL ULTRASOUND GUIDED PROSTATE BIOPSY: PERIPROSTATIC NERVE BLOCK, INTRARECTAL TOPICAL ANESTHESIA AND THEIR COMBINATION

You have accessJournal of UrologyProstate Cancer: Detection and Screening IV1 Apr 20122062 A SYSTEMATIC REVIEW AND META-ANALYSIS COMPARING THREE METHODS OF ANESTHESIA FOR TRANSRECTAL ULTRASOUND GUIDED PROSTATE BIOPSY: PERIPROSTATIC NERVE BLOCK, INTRARECTAL TOPICAL ANESTHESIA AND THEIR COMBINATION Liangren Liu, Ping Han, Yuchun Zhu, Xin Wei, Haichao Yuan, Shuo Zheng, and Qiang Wei Liangren LiuLiangren Liu Chengdu, China, People's Republic of More articles by this author , Ping HanPing Han Chengdu, China, People's Republic of More articles by this author , Yuchun ZhuYuchun Zhu Chengdu, China, People's Republic of More articles by this author , Xin WeiXin Wei Chengdu, China, People's Republic of More articles by this author , Haichao YuanHaichao Yuan Chengdu, China, People's Republic of More articles by this author , Shuo ZhengShuo Zheng Chengdu, China, People's Republic of More articles by this author , and Qiang WeiQiang Wei Chengdu, China, People's Republic of More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2227AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To review the current evidence to determine the contemporary status of periprostatic nerve block (PNB), intrarectal topical anesthesia(IRTA) and their combination in the pain control during TRUS guided prostate biopsy. METHODS A comprehensive search of the literature was performed in April, 2011 using Medline, Embase and Cochrane central register of controlled trials. All randomized controlled trial (RCT) related were included.Mean pain scores after the biopsy procedure and after the probe insertion and adverse events were evaluated. Heterogeneity of the included RCTs was analyzed using the chi-square test on N-1 degree of freedom, with an alpha of 0.10 and with I2 test.Meta-analyses were performed by the Review Manager 5.0. RESULTS 429 studies were initially identified from the electronic database and hand search£¬67 RCTs was assessed in the meta-analysis. (1) PNB, IRTA and their combination group had less mean pain during biopsy procedure than placebo or control group(PNB vs control: MD: −2.14, 95% CI: −2.52- −1.76, p<0.00001; PNB vs placebo: MD: −1.80, 95% CI: −2.45- −1.15, p<0.00001; IRTA vs control: MD: −0.99, 95%CI: −1.68- −0.29, p=0.005; IRTA vs placebo: MD: −0.56, 95% CI: −0.99- −0.13, p=0.01; PNB combined with IRTA vs control: MD: −2.17, 95% CI: −3.31- −1.03, p=0.0002; PNB combined with IRTA vs placebo: MD: −2.65, 95%CI: −3.30- −2.00, P<0.00001). (2) IRTA could significantly reduce pain during probe insertion comparing with control and placebo(IRTA vs control: MD: −2.39, 95% CI:−4.21- −.057, p=0.010; IRTA vs placebo: MD: −1.23, 95% CI: −1.58- −0.88, p<0.00001). (3) PNB group had less pain after the prostate biopsy than IRTA group ( MD: 1.39; 95%CI: 0.81-1.98; p<0.00001). (4) PNB combined with IRTA could significantly reduce pain during biopsy procedure compared with PNB and IRTA, respectively (PNB combined with IRTA vs PNB: MD: −0.40, 95% CI: −0.74- −0.05, p=0.03; PNB combined with IRTA vs IRTA: MD: −1.15, 95% CI: −2.05- −0.26, p=0.01). (5) No statistically significant differences were found in adverse events or serious events for three anesthesia method compared to placebo and control, respectively. CONCLUSIONS (1) PNB, IRTA and PNB combined with IRTA were efficacious and safe for patients undergoing TRUS guided prostate biopsy. (2) IRTA could reduce pain after probe insertion. (3) PNB was more effective in reducing pain after biopsy procedure than IRTA. (4) PNB combined with IRTA was the most effective method in reducing pain after prostate biopsy. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e832 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Liangren Liu Chengdu, China, People's Republic of More articles by this author Ping Han Chengdu, China, People's Republic of More articles by this author Yuchun Zhu Chengdu, China, People's Republic of More articles by this author Xin Wei Chengdu, China, People's Republic of More articles by this author Haichao Yuan Chengdu, China, People's Republic of More articles by this author Shuo Zheng Chengdu, China, People's Republic of More articles by this author Qiang Wei Chengdu, China, People's Republic of More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Doppler Ultrasonography-guided Pelvic Plexus Block before Systematic Needle Biopsy of the Prostate: A Prospective Randomized Study

To report a new method to block pelvic plexus and compare its efficacy with widely used periprostatic nerve block (PPNB) for transrectal ultrasonography-guided prostate biopsy. Pelvic plexuses were localized with the aid of color Doppler ultrasonography to create the pelvic block. This study was a single-center, prospective randomized trial. A total of 80 patients were recruited in 2 groups, with 40 patients in each. In group 1 (PPNB group), 2 mL of 2% lidocaine was injected between the prostate base and seminal vesicle on each side, using ultrasonic guidance. In group 2 (pelvic plexus block group), 2 mL of 2% lidocaine was injected into the region of the pelvic plexus lateral to the tip of vesicula seminalis on each side, using ultrasonic guidance. Color Doppler ultrasonography was used to identify injection sites. Patients were given an 11-point visual analog scale (VAS) to evaluate the level of pain encountered during probe insertion, injection of local anesthetic, and biopsy procedure. In both groups, probe insertion was the least painful stage. With regard to local anesthetic injection, VAS pain score was significantly lower in group 2 (2.05 vs 3.12, P = .0007). Sampling the prostate was the most painful stage in both groups and group 2 had significantly lower biopsy VAS pain scores (2.7 vs 4.97, P < .0001). There were no major complications. Administration of lidocaine in the area of the pelvic plexus under Doppler ultrasonographic guidance provides superior analgesia to PPNB, with limited morbidity during transrectal ultrasonography-guided biopsy of the prostate.

Control of Pain during Transrectal Ultrasound-Guided Prostate Biopsy: A Prospective Study Comparing Two Methods

Aim: To evaluate the efficacy of intramuscular injection of 75 mg diclofenac sodium and periprostatic nerve block (PPNB) with 1% lignocaine in controlling pain during transrectal ultrasound (TRUS)-guided prostate biopsy. Materials and Methods: A total of 120 patients undergoing TRUS-guided prostate biopsies were prospectively enrolled in the study. First, 20 patients did not get any form of analgesia/anesthesia and served as control; next, 20 patients received an intramuscular injection of diclofenac sodium. PPNB with 1% lignocaine was performed in the remaining 80 patients. Pain was assessed using Wong-Baker Faces Pain-Rating Scale (0–10). Results: All three groups of patients were comparable at baseline in terms of age, prostate-specific antigen and final histological diagnosis. The mean pain scores (±SD) for control, diclofenac and PPNB groups were 5.10 ± 3.14, 3.70 ± 2.36 and 2.24 ± 1.63, respectively. The difference was statistically significant between control and PPNB (p = 0.001), and diclofenac and PPNB (p = 0.002), but not between the control and diclofenac group (p = 0.120). In addition, the proportion of patients having mild or no pain (defined as pain score ≤3) during the biopsy was greater in the PPNB group (71%) compared with the diclofenac group (45%) and the control group (30%) (p = 0.001). The total duration for TRUS biopsy was not significantly different between the three groups (p = 0.114). Conclusion: PPNB with 1% lignocaine significantly decreases pain associated with prostate biopsy when compared with control and intramuscular diclofenac.