Transrectal ultrasonography (TRUS)‐guided pelvic plexus block to reduce pain during prostate biopsy: a randomised controlled trial

Abstract

ObjectiveTo assess the role of pelvic plexus block (PPB) in reducing pain during transrectal ultrasonography(TRUS)-guided prostate biopsy, compared with the conventional periprostatic nerve block (PNB). Patients and MethodsA prospective, double-blind observational study was conducted with patients being randomised into three groups. Group-1 (47 patients) received intrarectal local anaesthesia (IRLA) with 10 mL 2% lignocaine jelly along with pelvic plexus block (PPB) with 2.5 mL 2% lignocaine injection bilaterally. Group-2 (46 patients) received IRLA with periprostatic nerve block (PNB). Group-3 (46 patients) received only IRLA without any type of nerve block. The patients were requested to rate the level of pain from 0 to 10 on a visual analogue scale (VAS) at two time points: VAS-1: during biopsy procedure and VAS-2: 30 min after the procedure. ResultsThe mean age of the patients, mean volume of the prostates and mean serum PSA values were comparable among the three groups. The mean pain score during biopsy was significantly less in the PPB group [mean (range) sore of 2.91 (2-4)] compared with the PNB group [mean (range) score of 4 (3-5)], and both these groups were superior to the no nerve block group [mean score of 5.4 (3-7)]. There was no significant difference between the mean pain scores, 30 min after the procedure among the three groups with the mean (range) scores being 2.75 (2-4), 2.83 (2-4) and 2.85 (2-4), respectively. ConclusionPPB is superior to conventional periprostatic nerve block (PNB) for pain control during TRUS-guided biopsy and both are in turn superior to no nerve block.

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

“…Because the fibers innervating the prostate were derived mainly from pelvic plexus, local anesthesia in this location might be useful. In PPB, anesthesia was injected bilaterally into the pelvic plexus, therefore blocking all the nerve fibers and thus having a theoretical advantage over PNB21. Our meta-analysis showed that combination use of PPB and IRLA significantly reduced pain when compared with combination use of PNB and IRLA.…”

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

What is the most effective local anesthesia for transrectal ultrasonography-guided biopsy of the prostate? A systematic review and network meta-analysis of 47 randomized clinical trials

“…Color Doppler ultrasonography is helpful for identifying the entire pelvic plexus with no influence of the left lateral decubitus position 59 . Another two studies reported that PPB + IRLA has significantly more effective pain control than PNB + IRLA 17,24 . Although the currently available guidelines do not mention the use of PPB, our study suggests the possibility that PPB might be superior to PNB.…”

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

“…In the PPB group, lidocaine injections were administered to the pelvic neurovascular plexus, located at the end of the seminal vesicle, under Doppler-guided ultrasound, on each side [11,12,13,14]. In the PNB group, lidocaine injection was administered into the neurovascular bundles at the junction of the prostate–bladder–seminal vesicle, on each side, as described in previous studies [5,7,8,9,10,14]. After 5 min, a 12-core biopsy, covering the base, mid-zone, and apex bilaterally, was taken in all patients using an 18 G, 20 cm Max-Core disposable core biopsy instrument (CR Bard Inc., Covington, GA, USA).…”

“…Thus, PPB may be more effective for alleviating PBx-related pain, as compared to PNB [12]. Accordingly, several investigators have concluded that PPB is more effective than PNB through prospective randomized controlled trials (RCTs) [12,13,14]. However, the number of such studies is relatively small, making it difficult to draw solid conclusions in terms of reproducibility.…”