Pelvic plexus block to provide better anesthesia in transperineal template-guided prostate biopsy: a randomised controlled trial

Abstract

Background To evaluate the efficacy of pelvic plexus block (PPB) in relief pain during transperineal template-guided prostate biopsy (TTPB), compared with conventional periprostatic nerve block (PNB). Methods From July 2016 to August 2017, 245 patients who were performed TTPB in Clinical Medical College of Yangzhou University were recruited. The patients were randomized into three groups using a random number table. Group-1 received prostate capsule local anesthesia with 22 ml of 1% lidocaine. Group-2 additionally received PNB on the basis of Group-1. To perform PNB, 5 ml 1% lidocaine was injected into the region of prostatic neurovascular bundle situated in the angle of prostate-bladder-seminal vesicle. Group-3 received prostate capsule local anesthesia plus PPB (5 ml of 1% lidocaine injection into the pelvic plexus which located on lateral to the bilateral seminal vesicle apex). The patients’ pain and satisfaction were evaluated by visual analogue scale and visual numerical scale, respectively. Results The age, total prostate volume, PSA and the number of cores were comparable among the three groups. The visual analog scale scores of group-3 were significantly lower than group-2 during biopsy ( P = 0.003). Conversely, the visual numeric scale scores were higher in group-3 ( P = 0.039). Both the group-2 and group-3 outperformed the group-1 in alleviating pain and had a higher quantification of satisfaction. There were no significant differences in the pain scores or the satisfaction scores at 30 min after the procedure among the three groups. Conclusions The analgesic efficacy of PPB guided by Doppler ultrasound in TTPB was better than that of PNB and both were superior to no nerve block. Trial registration ChiCTR-IOR-17013533 , 01/06/2016.

Intraoperative Strategies to Reduce Catheter-Related Bladder Discomfort in the Early Postoperative Period after Robot-Assisted Radical Prostatectomy

“…14 Perivesical infiltration of ropivacaine targets both the postganglionic neurons in the detrusor wall and the pelvic plexus which is located at the bilateral apex of the seminal vesicles. 11 Periurethral infiltration targets the remnants of the neurovascular bundle at the apex. 14 Ropivacaine inhibits sodium ion influx in nerve fibers, 17 thereby blocking signal transmission and decreasing involuntary bladder muscle contraction.…”

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

“…There was no statistical difference for the pain control during biopsy between PPB and PNB. However, three studies ( 12 , 16 , 18 ) and one study ( 15 ) reported 40 to 50 ml and more than 50 ml prostate biopsy, respectively, and compared with PNB, PPB patients experienced less pain during biopsy ( Table 2 ).…”

“…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.…”