A Novel Pain Alternative for Patients with Anorectal Pathologies: The Comparison of Transperineal Prostatic Blockage Technique with Periprostatic Nerve Blockage and Rectal Gel Technique in Initial Transrectal Ultrasound-Guided Prostate Biopsy - A Prospective, Randomized Trial

Abstract

Introduction: The study aimed to compare the efficiency of periprostatic nerve blockage (PPNB) and intrarectal lidocaine gel (PPNB + gel) with a transperineal prostatic block (TPPB) technique during transrectal ultrasound-guided prostate biopsy (TRUS-PBx) in patients with anorectal pathologies. Materials and Methods: A total of 376 patients who underwent TRUS-PBx were randomized into 2 groups. Group-I (n = 198) received TPPB with 10 ml 2% prilocaine, and group-II (n = 178) received intrarectal administration of 10 ml 2% lidocaine gel followed by PPNB with 10 ml 2% prilocaine. A 10-point linear visual analogue scale (VAS) was used to assess the pain arising from probe insertion (VAS-1) and prostate sampling (VAS-2). Results: VAS-1 scores were significantly lower in group-I than group-II (1.7 ± 1.9 vs. 3.9 ± 1.5; p < 0.001). Combining local anesthesia produced superior pain control to TPPB during sampling (2.0 ± 1.2 vs. 2.5 ± 2.4; p = 0.015). Following subgroup analyses with reference to concomitant anorectal pathologies, VAS-1 scores were significantly lower in group-I than group-II (2.0 ± 1.8 vs. 5.5 ± 1.7; p < 0.001). VAS-2 scores were lower in group-II than group-I; however, the difference was not considered significant (2.4 ± 1.3 vs. 3.1 ± 2.8; p = 0.303). Conclusions: In all patients referred for TRUS-PBx, TPPB is a good alternative to PPNB + gel. TPPB can be particularly useful for patients with anorectal pathologies due to its improved pain reduction during probe insertion.

Comparison of Lidocaine and Prilocaine Efficiencies in Periprostatic Nerve Block for Transrectal Prostate Biopsy: A Randomized Prospective Study

“…In terms of patient comfort, it is important that the local anesthetic agent used in prostate biopsy has faster onset of action and provides longterm pain control. Although there are many previous studies in which lidocaine was used in PPNB, there are few studies comparing the effectiveness of prilocaine and lidocaine (12,13). This randomized prospective study was conducted to compare the effectiveness of two different active ingredients and three different methods used for pain control during and after TRUSguided standard 12-core prostate biopsy.…”

Prostat Biyopsisi Öyküsü Olan Hastalarda Transrektal Ultrason Kılavuzluğunda Yapılan Prostat Rebiyopsisi Sırasında Ağrı Skorları Değişiyor mu?

“…Günümüzde, prostatı inerve eden nörovasküler demetin Denonvillier fasyası içerisinde direkt anestezisini içeren periprostatik sinir blokajı (PPSB) standart teknik olarak önerilmektedir (6). Bu tekniğe alternatif olarak ileri sürülen transperineal PPSB (TPPSB) ise, özellikle anorektal patolojisi olan hastalarda uygulanabilecek güvenli ve etkili bir yöntemdir (7). Yapılan bazı çalışmalarda TRUS-PBx'ten önce uygulanan anestezi tekniğinin her hastada aynı etkiyi göstermediğini, bazı hastaların kombine yöntemlere ihtiyaç duyduğu gösterilmiştir (8).…”