Which anaesthesia should be recommended for prostate biopsy?

Mallick, S.; Braud, Frédéric; Fofana, M.; Humbert, Mathieu; Clervil, Mitelot; Blanchet, Pascal

doi:10.1590/s0043-31442005000200010

Cited by 5 publications

(4 citation statements)

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“…In addition, further studies were conducted through the early 2000s to compare the effectiveness of PILA to that of intrarectal lidocaine/lignocaine gels, as these were and are commonly used in urological clinics. Six randomised comparative studies showed that PILA is superior to lidocaine gel , while three studies concluded that there was no significant difference in pain scores during the procedure . A meta‐analysis that compared PILA with intrarectal lidocaine gels showed that a statistically significant pain reduction was achieved in the PILA group (six trials, 872 patients; standardised mean pain score difference −1.53, 95% CI −2.67 to −0.39, P = 0.008) .…”

Section: Resultsmentioning

confidence: 99%

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Current methods of analgesia for transrectal ultrasonography (TRUS)‐guided prostate biopsy – a systematic review

Lee

Woo

2014

BJU International

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Transrectal ultrasonography (TRUS)‐guided prostate biopsy is the most commonly used method of sampling prostate tissue for the diagnosis of prostate cancer. The technique is well recognised to potentially cause severe pain and discomfort for patients and this has led to numerous attempts to devise ways to minimise these problems. This systematic review summarises the techniques that have been described to date, with special reference to studies using either a visual analogue or numerical analogue scale to report outcomes. Commonly used approaches that are effective to minimise pain or discomfort include intravenous sedoanalgesia, inhalational agents and periprostatic infiltration of local anaesthetic. Whilst diclofenac suppositories are more effective than placebo, intra‐rectal local anaesthetic gels appear to be of no benefit. Performing TRUS‐guided prostate biopsy without any form analgesia is not appropriate.

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Section: Resultsmentioning

confidence: 99%

“…It should be noted that intrarectal lidocaine gel/cream as an adjunct is debated. Randomised trials do not have a consensus on the effectiveness of this method (Table ) .…”

Section: Resultsmentioning

confidence: 99%

Current methods of analgesia for transrectal ultrasonography (TRUS)‐guided prostate biopsy – a systematic review

Lee

Woo

2014

BJU International

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“…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

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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.

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“…were the first to describe the use of PNB before PBx in 1996 8 . Subsequently, many trials 2,9,12,21,22,25,28,30,34,36,37,40,42 and meta-analyses 7,54,55 have suggested that injection of local anesthetic around the nerve bundles might provide the best pain control during PBx. The results of our study also show that PNB significantly reduced pain compared with IRLA and placebo and are consistent with results from previous meta-analyses 7,54–56 .…”

Section: Discussionmentioning

confidence: 99%

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

Kim

Lee

Jung

et al. 2019

Sci Rep

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We aimed to compare the effectiveness of various local anesthetic methods for controlling prostate biopsy (PBx) related pain using network meta-analysis. Literature searches were performed on PubMed/Medline, Embase, and Cochrane Library up to March 2018. Forty-seven randomized controlled trials, in which the effectiveness of PBx-related pain was investigated using a visual analogue scale after various local anesthetic methods, were included. The local anesthetic methods included intraprostatic local anesthesia (IPLA), intrarectal local anesthesia (IRLA), intravenous sedation (IVS), periprostatic nerve block (PNB), pelvic plexus block (PPB), and spinal anesthesia (SPA). Eight pairwise meta-analyses and network meta-analyses with 21 comparisons were performed. All modalities, except single use of IPLA and IRLA, were more effective than placebo. Our results demonstrate that PNB + IVS (rank 1) and SPA (rank 2) were the most effective methods for pain control. The followings are in order of PPB + IRLA, PNB + IPLA, PPB, PNB + IRLA, IVS, and PNB. In conclusion, the most effective way to alleviate PBx-related pain appears to be PNB + IVS and SPA. However, a potential increase in medical cost and additional risk of morbidities should be considered. In the current outpatient setting, PPB + IRLA, PNB + IPLA, PPB, PNB + IRLA, and PNB methods are potentially more acceptable options.

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Which anaesthesia should be recommended for prostate biopsy?

Cited by 5 publications

References 0 publications

Current methods of analgesia for transrectal ultrasonography (TRUS)‐guided prostate biopsy – a systematic review

Current methods of analgesia for transrectal ultrasonography (TRUS)‐guided prostate biopsy – a systematic review

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

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