A meta-analysis of local anesthesia for transrectal ultrasound-guided biopsy of the prostate

Abstract

This meta-analysis evaluated the efficacy and safety of periprostatic nerve block (PPNB) and intrarectal local anesthestic (IRLA) gel in alleviating pain during prostate biopsy. Electronic databases MEDLINE, Cochrane Central Register of Controlled Trials and EMBASE were searched to identify all randomized controlled trials comparing PPNB with periprostatic placebo injection, no injection or with IRLA. Studies for inclusion were identified and extracted by two authors independently. The main outcome measure was patients' assessment of mean pain scores on a 10-point scale at the end of the biopsy procedure. Secondary outcomes were complications and adverse events. Continuous data from the trials were combined by calculating the weighted mean difference (WMD) with its 95% confidence interval. In total, 25 studies met the inclusion criteria. Twenty studies involving 1685 patients compared PPNB with either no anesthesia or with placebo injection controls, showing a significant reduction in pain score in the anesthetic group (WMD À2.09, 95% CI À2.44 to À1.75, Po0.00001). Five studies with 466 patients compared IRLA and control. Although IRLA was associated with pain reduction, the effect size was not statistically significant (WMD À0.22, 95% CI À0.56 to 0.12). Six studies with 872 patients compared PPNB with IRLA, showing a significant pain reduction in the former group (WMD À1.53, 95% CI À2.67 to À0.39, P ¼ 0.008). No trials reported an increase in complications in the treatment arms. In conclusion, the evidence from randomized controlled trials shows that local anesthetic given as a PPNB, but not as an intrarectal instillation, is effective and safe in alleviating pain from transrectal ultrasound biopsy of the prostate.

Local Anesthesia for the Prostate Gland

“…These results are supported by a meta-analysis of 6 studies with 872 patients comparing peri-prostatic nerve block to intra-rectal local anesthetic. 53 The authors reported a weighted mean difference of -1.53, 95% CI -2.67 to -0.39 (p=0.008), on a 10 point scale in favor of peri-prostatic nerve block over intra-rectal local anesthetic.…”

“…A recent meta-analysis involving 5 studies and 466 patients found the intrarectal local anesthetic provided better pain relief then no anesthetic or placebo, but the weighted mean difference between the groups did not reach statistical significance. 53 Other studies have suggested that intra-rectal local anesthetic alone is not sufficient for pain relief during the biopsy procedure. 59 Although it works well to reduce the pain associated with probe insertion it does not address the pain associated with injection of the prostate capsule.…”

“…This study has been supported by many meta-analysis, which have showed a benefit in pain reduction during biopsy with peri-prostatic injection of local anesthetic compared to placebo or no anesthesia. [51][52][53] A recent meta-analysis involving 20 studies and 1685 patients found a significant reduction in pain (weighted mean difference of -2.09, 95% CI -2.44 to -1.75, p<0.0001 on a 10 point scale) when comparing peri-prostatic nerve block to no anesthesia or placebo. 53 These authors found similar benefits for peri-prostatic nerve block over no anesthesia or placebo regardless of the site injected.…”

“…28 S t u d i e s h a v e a l s o r e p o r t e d n o d i f f e r e n c e i n i n t r a o p e r a t i v e f i n d i n g s s u c h a s fibrosis or loss of planes between the rectum and prostate at radical prostatectomy after prostate biopsy with local anesthetic. 53 …”

Neuraxial anesthesia versus general anesthesia for urological surgery: systematic review

“…1,2 A systematic review relating to urological surgery analyzed pain scores and other secondary outcomes without looking for mortality in the context of the choice of anesthetic technique. 1,3 In this context, we conducted a study to answer one research question: what is the difference in mortality rate between using general anesthesia and using neuraxial anesthesia for urological surgery?…”