Comparative Evaluation of Periprostatic Nerve Block with and without Intraprostatic Nerve Block in Transrectal Ultrasound-Guided Prostatic Needle Biopsy

Singh, Santosh Kumar; Kumar, Ashok; Griwan, Mahavir Singh; Sen, Jyotsna

doi:10.4111/kju.2012.53.8.547

Cited by 9 publications

(12 citation statements)

References 18 publications

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“…For that reason, a good pain control is mandatory, especially in order to prevent patient's refusal to repeat biopsy. Some studies have showed that about 20% of patients who underwent biopsy would reject rebiopsy without any kind of analgesia (7). According to our results, the rate of tolerability in group 1 was about 73.2% and the rate of patient consent for repeating the procedure was about 34.1% in the same group.…”

Section: Discussionsupporting

confidence: 51%

Pain Control and Its Relationship with Histopathological Outcome in TRUS-Guided Prostate Needle Biopsy: A Prospective Non-Randomized Trial

Demir¹,

Çeçen²,

Karadağ³

et al. 2015

jus

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What's known on the subject? and What does the study add? ÖZET objective Transrectal ultrasound-guided prostate biopsy (TRUS-Bx) is a standard diagnostic modality for detecting prostate cancer (PCa). Pain during biopsy is the most important problem that still needs a solution. The purpose of this study was to compare 3 pain control techniques and to investigate the relationship between the level of pain and histopathological findings. Materials and Methods 139 patients underwent prostate biopsy utilizing 3 analgesic techniques; 1-using lidocain gel (group 1), 2-pethidine+diazepam (group 2) and 3-periprostatic nerve block (group 3). Pain level, the tolerability and repetition of the procedure were questioned. The pathological findings were recorded. Results There was a statistically significant difference between group 1 and the others with regard to tolerability and repeating the procedure. The pain score during biopsy in group 1 was greater than in the other groups and those in group 2 was higher than in group 3. The mean pain score during probe insertion in group 2 was lower than in groups 1 and 3. The mean pain score taken during the biopsy was higher than that during probe insertion in group 2. However, the mean pain score during probe Amaç TRUS-biyopsi, prostat kanseri tanısında hala en kesin tanısal yöntemdir. Biyopsi esnasında oluşan ağrı ise başedilmesi gereken en önemli sorundur. Bu çalışmanın amacı, 3 farklı ağrı kontrol tekniği kıyaslamak ve ağrı düzeyi ile hastadaki mevcut patoloji arasındaki ilişkiyi araştırmaktır. gereç ve yöntem Yüz otuz dokuz hastaya, 3 farklı ağrı kontrol tekniği, kullanılarak prostat biyopsisi yapıldı. Gruplar sırasıyla; lidokain jel, petidin+diazepam, periprostatik sinir blokajı olarak belirlendi. Ağrı düzeyleri yanında, tolerabilite ve işlemi gerektiğinde tekrarlatma durumları sorgulandı. Patolojik sonuçlar kaydedildi. Bulgular Tolerabilite ve işlemi gerektiğinde tekrarlatma oranları arasındaki fark, grup 1'de diğer gruplara göre farklıydı. Ağrı skorları bakımından, grup 1 ve grup 2 diğer gruplardan istatistiksel olarak farklıydı. Prob yerleştirimi esnasındaki ağrı skorları, grup 2'de diğer gruplardan istatistiksel olarak anlamlı düzeyde farklıydı. Ayrıca, grup 2'de, biyopsi esnasında oluşan ağrı düzeyi skoru, prob yerleştirimi esnasındakinden daha fazlaydı. Ancak, grup 3 için prob yerleştirimi esnasında oluşan ağrı düzeyi skoru grup 1'dekinden farklı değildi. Gruplar arasında, patolojik sonuçlar açısından, Pain during prostate biopsy is the most important problem which need a solution. The purpose of this study is to compare 3 pain control techniques and its relationship with pathology. According to our research in the literature, our study is the first study that investigate the relationship between pain level during prostate biopsy and the exist pathology in the patient.

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Section: Discussionsupporting

confidence: 51%

Pain Control and Its Relationship with Histopathological Outcome in TRUS-Guided Prostate Needle Biopsy: A Prospective Non-Randomized Trial

Demir¹,

Çeçen²,

Karadağ³

et al. 2015

jus

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“…1). After screening 46 RCTs15678910111213141516171819202122232425262728293031323334353637383940414243444546474849 met our study criteria and were included in our meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

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

Wang

et al. 2017

Sci Rep

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A meta-analysis was performed to evaluate the efficacy of local anesthesia in alleviating pain during prostate biopsy. We searched relevant articles in PubMed and Embase. The included studies should be randomized controlled trials (RCT) using local anesthesia to alleviate pain during biopsy, which was recorded by a pain scale. Analgesic efficacy of different local anesthesia techniques were analyzed, including intrarectal local anesthesia (IRLA), periprostatic nerve block (PNB), pelvic plexus block (PPB) and intraprostatic local anesthesia (IPLA). We included 46 RCTs. PNB significantly reduced pain score compared with placebo (−1.27 [95% confidence interval [95% CI] −1.72, −0.82]) or no injection (−1.01 [95% CI −1.2, −0.82]). IRLA with prilocaine-lidocaine cream could also reduced pain (−0.45 [95% CI −0.76, −0.15]), while the IRLA with lidocaine gel was not effective (−0.1 [95% CI −0.24, 0.04]). PNB lateral to the neurovascular bundle had better analgesic effect than at prostate apex (P = 0.02). Combination use of PPB and IRLA considerably alleviated pain of patients compared with the combination of PNB and IRLA (−1.32 [95% CI −1.59, −1.06]). In conclusion, local anesthesia could alleviate patients’ pain during the prostate biopsy. PNB was not so effective as PPB.

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“… 6 – 31 Eight articles compared IRLA with no anesthesia or placebo gel; 6 – 13 six articles compared PPNB with no anesthesia; 7 , 11 , 14 – 17 three articles compared PPNB with periprostatic placebo injection; 10 , 14 , 18 six articles compared PPNB with IRLA; 7 , 10 , 11 , 19 , 21 nine articles compared combined PPNB and IRLA with PPNB alone; 21 – 29 and four articles compared combined PPNB and IPNB with PPNB alone. 15 , 17 , 30 , 31 For studies comparing PPNB with periprostatic placebo injection, an equivalent volume of normal saline was used. In all studies, biopsies were operated with an 18 G needle, and six to 14 core biopsies were performed for the participants.…”

Section: Resultsmentioning

confidence: 99%

Local anesthesia for pain control during transrectal ultrasound-guided prostate biopsy: a systematic review and meta-analysis

Yan

Wang

Huang

et al. 2016

JPR

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BackgroundA meta-analysis was performed to evaluate the efficacy and safety of intrarectal local anesthestic (IRLA), periprostatic nerve block (PPNB), and the combined modalities in alleviating the pain during transrectal ultrasound (TRUS)-guided prostate biopsy.Materials and methodsA literature review was performed to identify all published randomized controlled trials (RCTs) about IRLA vs no anesthesia or placebo gel; PPNB vs no injection, periprostatic placebo injection, or IRLA; combined PPNB and IRLA vs PPNB alone; and combined PPNB and intraprostatic nerve block (IPNB) vs PPNB alone before TRUS-guided biopsy. Sources included MEDILINE, EMBASE, and Cochrane Library from 1980 to 2016. The main outcomes were biopsy pain score, probe manipulation pain score, and anesthetic infiltration pain score assessed by the visual pain scale.ResultsA total of 26 articles involving 36 RCTs were used in this analysis: Although IRLA can lead to pain reduction, the result was not statistically significant when compared with no anesthesia or placebo gel (weighted mean difference [WMD]: −0.22, 95% CI: −0.45 to 0, P=0.06). PPNB can lead to significantly lower biopsy pain scores when compared with no analgesia (WMD: −1.32, 95% CI: −1.68 to −0.95, P<0.00001), placebo injection (WMD: −2.62, 95% CI: −3.16 to −2.07, P<0.00001), or IRLA (WMD: −1.31, 95% CI: −1.40 to −1.22, P<0.00001). PPNB + IRLA can lead to significantly lower biopsy pain scores when compared with PPNB alone (WMD: −0.45, 95% CI: −0.62 to −0.28, P<0.00001). PPNB + IPNB can lead to significantly lower biopsy pain scores when compared with PPNB alone (WMD: −0.73, 95% CI: −0.92 to −0.55, P<0.00001). There were no severe reported general or local complications related to local anesthesia.ConclusionThis meta-analysis indicates that a combination of PPNB and IRLA/IPNB is effective and safe in alleviating the pain during TRUS-guided prostate biopsy. Further high-quality RCTs are needed to validate this result.

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Comparative Evaluation of Periprostatic Nerve Block with and without Intraprostatic Nerve Block in Transrectal Ultrasound-Guided Prostatic Needle Biopsy

Cited by 9 publications

References 18 publications

Pain Control and Its Relationship with Histopathological Outcome in TRUS-Guided Prostate Needle Biopsy: A Prospective Non-Randomized Trial

Pain Control and Its Relationship with Histopathological Outcome in TRUS-Guided Prostate Needle Biopsy: A Prospective Non-Randomized Trial

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

Local anesthesia for pain control during transrectal ultrasound-guided prostate biopsy: a systematic review and meta-analysis

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