Efficacy and safety of peri-prostatic local anaesthetic injection in trans-rectal biopsy of the prostrate: A prospective randomised study

Nambirajan, Thiagarajan; Woolsey, Siobhan; Mahendra, V.; Walsh, Ian; Lynch, Thomas; Keane, Patrick F.

doi:10.1016/s1479-666x(04)80004-0

Cited by 23 publications

(23 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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

View full text Add to dashboard Cite

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.

show abstract

“…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

View full text Add to dashboard Cite

show abstract

“…No significant difference in hematuria and hematochezia between LA and CT. Mallick [43] No difference (LA vs. CT) in hematuria (2% vs. 2%), hematospermia (1% vs. 1%). Vanni [55] No difference in hematuria and rectal bleeding between LA & CT. Nambirajan [44] No significant difference in hematuria (8.4% vs. 10.4%), rectal bleeding (8.4% vs. 6.3%), hematospermia (18.8% vs. 23%) and infection (8.3% vs. 10.4%) between groups (LA vs. CT). Obek [45] Higher rate of complications in periprostatic infiltration but not significantly different.…”

Section: Intrarectal Lignocainementioning

confidence: 91%

“…Randomization methods were judged to be adequate in 10 studies. [34][35][36]42,44,[51][52][53]19,56 They were not specified in the remaining 15 trials. 14,[37][38][39][40][41]43,[45][46][47][48][49][50]54,55 For the trials assessing the efficacy of PPNBs, two types of controls were used.…”

Section: Study Description and Validitymentioning

confidence: 99%

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

Tiong

Liew

Samuel

et al. 2007

Prostate Cancer Prostatic Dis

View full text Add to dashboard Cite

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.

show abstract

“…A single dosage of 400 mg oral ofloxacin and 80 mg intravenous gentamicin was given before the procedure. The prostate was infiltrated with 10 ml of 1% lidocaine as a local anesthetic at the base of each lateral lobe with a 16-gauge spinal needle before TRUS biopsy as per the protocol [6]. A total of 200 mg of oral ofloxacin was also prophylactically prescribed to all patients for the evening of TRUS biopsy and the following morning.…”

Section: Methodsmentioning

confidence: 99%

Discontinuation of Anticoagulant or Antiplatelet Therapy for Transrectal Ultrasound-Guided Prostate Biopsies: A Single-Center Experience

et al. 2012

View full text Add to dashboard Cite

PurposeHistorically, it was thought that hemorrhagic complications were increased with transrectal ultrasound-guided prostate biopsies (TRUS biopsy) of patients receiving anticoagulation/antiplatelet therapy. However, the current literature supports the continuation of anticoagulation/antiplatelet therapy without additional morbidity. We assessed our experience regarding the continuation of anticoagulation/antiplatelet therapy during TRUS biopsy.Materials and MethodsA total of 91 and 98 patients were included in the anticoagulation/antiplatelet (group I) and control (group II) groups, respectively. Group I subgroups consisted of patients on monotherapy or dual therapy of aspirin, warfarin, clopidogrel, or low molecular weight heparin. The TRUS biopsy technique was standardized to 12 cores from the peripheral zones. Patients completed a questionnaire over the 7 days following TRUS biopsy. The questionnaire was designed to assess the presence of hematuria, rectal bleeding, and hematospermia. Development of rectal pain, fever, and emergency hospital admissions following TRUS biopsy were also recorded.ResultsThe patients' mean age was 65 years (range, 52 to 74 years) and 63.5 years (range, 54 to 74 years) in groups I and II, respectively. The overall incidence of hematuria was 46% in group I compared with 63% in group II (p=0.018). The incidence of hematospermia was 6% and 10% in groups I and II, respectively. The incidence of rectal bleeding was similar in group I (40%) and group II (39%). Statistical analysis was conducted by using Fisher exact test.ConclusionsThere were fewer hematuria episodes in anticoagulation/antiplatelet patients. This study suggests that it is not necessary to discontinue anticoagulation/antiplatelet treatment before TRUS biopsy.

show abstract

Efficacy and safety of peri-prostatic local anaesthetic injection in trans-rectal biopsy of the prostrate: A prospective randomised study

Cited by 23 publications

References 23 publications

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

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

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

Discontinuation of Anticoagulant or Antiplatelet Therapy for Transrectal Ultrasound-Guided Prostate Biopsies: A Single-Center Experience

Contact Info

Product

Resources

About