Is periprostatic nerve block a gold standard in case of transrectal ultrasound-guided prostate biopsy?

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

doi:10.4103/0974-7796.115732

Cited by 12 publications

(12 citation statements)

References 20 publications

(14 reference statements)

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“…Gill et al 26 reported on 234 patients undergoing the same TRUS TR procedure with the addition of a periprostatic nerve block, which is considered the gold standard for TRUS-guided prostate biopsy. 27 Of those patients who gave a pain score, only 21.9% of patients in total scored pain at 2 or higher and 75% patients scored pain as 1 or 0 (very mild or no pain), and the mean pain score was lower than that observed by Igdem et al at 1.1.…”

Section: Fiducial Marker Implantationcontrasting

confidence: 39%

Fiducial marker guided prostate radiotherapy: a review

O’Neill¹,

Jain²,

Hounsell³

et al. 2016

The British Journal of Radiology

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Image-guided radiotherapy (IGRT) is an essential tool in the accurate delivery of modern radiotherapy techniques. Prostate radiotherapy positioned using skin marks or bony anatomy may be adequate for delivering a relatively homogeneous whole-pelvic radiotherapy dose, but these surrogates are not reliable when using reduced margins, dose escalation or hypofractionated stereotactic radiotherapy. Fiducial markers (FMs) for prostate IGRT have been in use since the 1990s. They require surgical implantation and provide a surrogate for the position of the prostate gland. A variety of FMs are available and they can be used in a number of ways. This review aimed to establish the evidence for using prostate FMs in terms of feasibility, implantation procedures, types of FMs used, FM migration, imaging modalities used and the clinical impact of FMs. A search strategy was defined and a literature search was carried out in Medline. Inclusion and exclusion criteria were applied, which resulted in 50 articles being included in this review. The evidence demonstrates that FMs provide a more accurate surrogate for the position of the prostate than either external skin marks or bony anatomy. A combination of FM alignment and soft-tissue analysis is currently the most effective and widely available approach to ensuring accuracy in prostate IGRT. FM implantation is safe and well tolerated. FM migration is possible but minimal. Standardization of all techniques and procedures in relation to the use of prostate FMs is required. Finally, a clinical trial investigating a non-surgical alternative to prostate FMs is introduced.

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Section: Fiducial Marker Implantationcontrasting

confidence: 39%

Fiducial marker guided prostate radiotherapy: a review

O’Neill¹,

Jain²,

Hounsell³

et al. 2016

The British Journal of Radiology

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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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“…In addition, periurethral infiltration with local anesthetic before operation can also reduce immediate postoperative pain. 27,28 However, these approaches have not been introduced in the management of CRBD. Further studies in this area are warranted.…”

Section: Discussionmentioning

confidence: 99%