Is Pelvic Plexus Block Superior to Periprostatic Nerve Block for Pain Control during Transrectal Ultrasonography-Guided Prostate Biopsy? A Double-Blind, Randomized Controlled Trial

Abstract

We evaluated whether pelvic plexus block (PPB) is superior to periprostatic nerve block (PNB) for pain control during transrectal ultrasonography (TRUS)-guided prostate biopsy (PBx). A prospective, double-blind, randomized, controlled study was performed at a single center; 46 patients were enrolled and randomly allocated into two groups: PPB (n = 23) and PNB (n = 23). The visual analogue scale (VAS) was used; pain scores were measured four times: during local anesthesia, probe insertion, sampling procedures, and at 15 min post procedures. No significant differences were observed in VAS scores during local anesthesia (2.30 for PPB vs. 2.65 for PNB, p = 0.537) or during probe insertion (2.83 for PPB vs. 2.39 for PNB, p = 0.569). Similarly, no differences in VAS scores were detected during the sampling procedures (2.83 for PPB vs. 2.87 for PNB, p = 0.867) and at 15 min post procedures (1.39 for PPB vs. 1.26 for PNB, p = 0.631). No major complications were noted in either group. Both PPB and PNB are comparably effective and safe methods for PBx related pain relief, and PPB is not superior to PNB. Local anesthetic method could be selected based on the preference and skill of the operator.

Pelvic Plexus Block Versus Periprostatic Nerve Block for Ultrasound-Guided Prostate Biopsy: A Meta-Analysis

“…Two studies ( 17 , 19 ) compared the pain control for patients’ prostate volume less than 40 ml between these two groups. There was no statistical difference for the pain control during biopsy between PPB and PNB.…”

“…By removing duplicates, reviews, and articles that were not relevant to the question, 11 articles were remained. Then, after full-text screening of these articles, six articles (12,(15)(16)(17)(18)(19) were assessed for eligibility. Further evaluations and detailed analysis of the articles were shown in Figure 1.…”

“…Five studies (12,15,(17)(18)(19) and one study (16) reported transrectal and transperineal prostate biopsy, respectively. The pooled results showed that compared with PNB, PPB patients experienced less pain during biopsy, regardless of transrectal or transperineal approach (Table 2).…”

“…However, previous meta-analyses (13,14) only have included two studies and the number of cases is relatively small, and only VAS scores were compared, no complications were compared. In the past few years, more prospective randomized controlled trials (RCTs) comparing PPB and PNB drew conflicting conclusions (12,(15)(16)(17)(18)(19). Thus, in order to get more reliable evidence to guide clinical practice, a meta-analysis is necessary to determine whether PPB is superior to PNB for pain control during ultrasoundguided prostate biopsy.…”

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

“…To date, several different analgesic techniques have been investigated to provide more effective analgesic control than PNB, which include intrarectal local anesthesia, perianal local anesthetic injection, various analgesics such as oral nonsteroidal antiinflammatory agents and opioids, application of inhaled mixture of nitrous oxide and oxygen, selective low-dose spinal anesthesia, caudal block, and pelvic plexus block [ 10 – 16 ]. Although all these techniques provide more effective pain control alone when compared with placebo, none of them is better than PNB.…”