Local anesthesia for ultrasound guided prostate biopsy: a prospective randomized trial comparing 2 methods

PURPOSE: Since the introduction of prostate specific antigen (PSA) screening, asymptomatic men often undergo transrectal ultrasound guided prostate biopsy. This procedure may cause significant discomfort, which may limit the number of biopsies. We performed a randomized prospective study to compare periprostatic infiltration with 1% lidocaine with intrarectal instillation of 2% lidocaine gel before prostate biopsy. MATERIALS AND METHODS: From October 1999 to July 2000, 150 men underwent prostate biopsy at the Miami Veterans Administration and Jackson Memorial Hospital. Experienced senior residents performed all biopsies. Patients were randomized into 2 groups depending on the method of anesthetic delivery. A visual analog scale was used to assess the pain score. Statistical analysis of pain scores was performed using the Student t test. RESULTS: Ultrasound guided prostate biopsy was done in 150 cases. There was a statistical difference in the mean pain score after periprostatic infiltration and intrarectal instillation (2.4 versus 3.7, p = 0.00002) with patients receiving periprostatic infiltration reporting significantly less pain. CONCLUSIONS: Men should have the opportunity to receive local anesthesia before ultrasound guided prostate biopsy with the goal of decreasing the discomfort associated with this procedure. Our prospective randomized study indicates that ultrasound guided periprostatic nerve block with 1% lidocaine provides anesthesia superior to the intrarectal placement of lidocaine gel.     

Periprostatic local anesthesia before transrectal ultrasound-guided prostate biopsy

PURPOSE: We prospectively assessed the safety and efficacy of periprostatic local anesthesia before transrectal ultrasound (TRUS)-guided prostate biopsy. MATERIALS AND METHODS: A total of 178 consecutive men undergoing transrectal prostate biopsy at our institution were enrolled in this study. From January to June 2001, 84 men underwent prostate biopsy without anesthesia (control group). From July to December 2001, 94 men received local anesthesia before prostate biopsies (anesthesia group). A 5-ml dose of 1% lidocaine was injected into the periprostatic nerve plexus on each side via a 22 gauge needle at 3 minutes before the procedure. Pain during and after biopsy was assessed using a 10-point visual analog scale (VAS). Complications were evaluated with a self-administered questionnaire. RESULTS: The average pain score during biopsy was 3.18 in the anesthesia group versus 4.16 in the control group (p = 0.0067), while average pain score on the next day was 2.12 and 2.25, respectively (p = 0.7451). In the anesthesia group 13% of patients had a pain score > 5 versus 34% in the control group (p = 0.0043). The complication rate showed no significant difference between the two groups. CONCLUSION: Periprostatic lidocaine injection is a safe and effective method of anesthesia for transrectal prostate biopsy.     

前列腺穿刺活检术中不同麻醉方法有效性和安全性比较

目的 比较3种麻醉方法 在经直肠超声引导下前列腺穿刺活检过程中的有效性和安全性.方法 2006年7月至2008年10月,120名因前列腺特异抗原和(或)直肠指检异常接受前列腺12针穿刺活检的患者随机分为4组,每组30例.A组为对照组,未接受任何麻醉;B组在超声引导下于左、右两侧精囊与前列腺交接处分别注射1%利多卡因5ml行前列腺神经阻滞术(PNB);C组在PNB之前5 min直肠内涂抹复方利多卡因凝胶;D组在PNB之前于前列腺两侧叶内分别注射1%利多卡因2 ml.穿刺结束后对患者进行疼痛视觉模拟评分(VAS),并随访7 d了解并发症情况.结果 超声探头进入直肠时C组患者的VAS为(2.7±1.1)分,低于其他3组,差异有统计学意义(P＜0.05),其他3组之间差异无统计学意义(P＞0.05).穿刺过程中D组患者的VAS为(3.9±1.3)分低于其他3组,差异有统计学意义(P＜0.05),其他3组之间差异无统计学意义(P＞0.05).各组患者并发症的发生率差异无统计学意义(P＞0.05).结论 PNB及直肠内利多卡因凝胶局部麻醉不能明显减轻前列腺穿刺过程中的痛苦,PNB联合前列腺内局部麻醉是安全有效的.     

Prospective study comparing two methods of anaesthesia for prostate biopsies: apex periprostatic nerve block versus intrarectal lidocaine gel: review of the literature

INTRODUCTION: Studies have demonstrated the need for pain control during multiple transrectal prostate biopsies. Due to encountered published results on periprostatic nerve block, we prospectively evaluated the efficacy and safety of periprostatic local anaesthesia at the apex in comparison to intrarectal lidocaine gel. METHODS: From January 2001 to January 2002 110 patients underwent prostate biopsy. Patients were randomized to receive 10 cc of either 2% lidocaine gel intrarectally (Group 1) or 10 cc of 1% lidocaine solution injected under ultrasound guidance for bilateral periprostatic nerve block at the apex (Group 2). Pain during biopsy was assessed using a 10-point linear visual analog pain scale and a 5-point digital visual pain scale (continuous variables). Statistical analysis of pain scores was performed using the Student t-test. RESULTS: 96 patients fitted the inclusion and presented no exclusion criteria. 43 patients composed group 1, and 53 patients group 2. The mean pain score was 2.76+/-1.69 and 1.73+/-1.26 for group 1 and 2, respectively for the 10-point linear visual analog pain scale (p=0.001). The mean pain score was 2.26+/-0.82 and 1.62+/-0.56 for groups 1 and 2, respectively for the 5-point digital visual pain scale (p<0.001). There was no difference in mean patient age (p=0.348), prostate size (p=0.899), serum PSA (p=0.932), and complications when comparing both groups. The number of biopsies per patient was significantly higher in group 2 (p=0.006), but pain scores in each scale were significantly less. CONCLUSIONS: Periprostatic nerve block at the apex is superior to intrarectal lidocaine gel for controlling pain during transrectal prostate biopsy, with no increased complications. This technique should be recommended for those patients without anal or rectal inflammatory diseases.     

Bilateral fine-needle administered local anaesthetic nerve block for pain control during TRUS-guided multi-core prostate biopsy: a prospective randomised trial

INTRODUCTION: Transrectal multi-core biopsies of the prostate can cause substantial discomfort with the need for high dose systemic analgesics. In a prospective randomised trial we investigated the efficacy of fine-needle administered local anaesthesia for bilateral prostatic nerve block prior to transrectal ultrasound (TRUS) guided prostate biopsy.MATERIALS AND METHODS: One hundred and eight men suspected of having cancer of the prostate were randomised to receive TRUS-guided bilateral prostate nerve block prior to biopsy or not, when having no history of previous prostate biopsies (groups I and II, n=68). In group III (n=40) all patients with history of previous biopsies exclusively received local anaesthesia injection. Patients routinely underwent a 10-core biopsy regimen. For repeat biopsy 12 cores were taken. The consented patients documented pain on a visual analogue pain score.RESULTS: In the randomised groups I and II average pain score was 1.85 with versus 3.29 without periprostatic nerve block (p<0.0001). In group III the difference in pain stated for the present biopsy with local anaesthesia nerve block in comparison to the pain experienced with the previous biopsy solely under transrectal lidocaine gel was even higher (1.71 versus 4.59; p<0.0001). Pain relief was independent of the number of biopsy cores sampled. Overall cancer detection rate was 46% (50/108).CONCLUSION: Bilateral local anaesthesia nerve block prior to multi-core TRUS-guided prostate biopsy significantly reduces pain independent of the number of cores taken.     

Efficacy of periprostatic nerve blockade during ultrasound-guided transrectal 10-core biopsy of the prostate

PURPOSE: We examined the efficacy and safety of periprostatic nerve blockade during transrectal ultrasound guided prostate biopsy. MATERIALS AND METHODS: Transrectal ultrasound guided 10 core biopsy of the prostate was performed in 116 consecutive men. From March 2002 to July 2003, 58 men underwent biopsy of the prostate without local anesthesia (control group). From August 2003 to March 2004, 58 men received periprostatic nerve blockade before prostate biopsies (anesthesia group). A 4-ml dose of 1% lidocaine was injected at 2 or 3 locations on each side of the prostate via a 23 gauge needle. Pain during biopsy was questioned using a 5-point Face scale and complications were also recorded. RESULTS: The average pain score during biopsy was 1.9 in the anesthesia group versus 3.1 in the control group (p<0.001). In the anesthesia group 20.7% of patients had a pain score 3 or greater than 3 versus 69% in the control group. The complication rate showed no significant difference between the two groups. CONCLUSIONS: Periprostatic nerve blockade is a safe and effective method of anesthesia for transrectal prostate biopsy.     

Does the intrarectal instillation of lidocaine gel before periprostatic neurovascular bundle block during transrectal ultrasound guided prostate biopsies improve analgesic efficacy? A prospective, randomized trial

PURPOSE: We assessed the analgesic effect of additional intrarectal lidocaine gel instillation during transrectal ultrasound guided prostate biopsy and identified the procedural steps that benefit from lidocaine gel instillation. MATERIALS AND METHODS: A total of 250 consecutive patients scheduled for prostate biopsy were randomized into 2 groups. In the 125 group 1 patients lidocaine gel was instilled intrarectally before periprostatic neurovascular bundle block. The 125 patients in group 2 underwent only periprostatic neurovascular bundle block without lidocaine gel instillation. Of the 250 patients 90 in group 1 and 113 in group 2, in whom 12 systematic cores were obtained, were enrolled for data analysis. Pain was assessed using a visual analog scale during periprostatic neurovascular bundle block (visual analog scale 1), during biopsy (visual analog scale 2) and 20 minutes after biopsy (visual analog scale 3). Differences between the visual analog scale scores of the 2 groups at each procedural step were evaluated using the unpaired t test with p<0.05 considered significant. RESULTS: In terms of pain experienced during the 3 procedural steps scores were significantly different during biopsy (p<0.01). Visual analog scale scores of patients in group 1 showed a tendency to be lower than the scores of patients in group 2 during periprostatic neurovascular bundle block and 20 minutes after biopsy (p=0.11 and 0.20, respectively). CONCLUSIONS: Intrarectal lidocaine gel instillation before periprostatic neurovascular bundle block produces a significant additional analgesic effect during biopsy. The procedure is simple, safe and rapid, and it should be considered in all patients undergoing transrectal ultrasound guided prostate biopsy.     

Lack of effect of intrarectal lidocaine for pain control during transrectal prostate biopsy: a randomized prospective study

INTRODUCTION AND OBJECTIVES: Transrectal ultrasound guided biopsy is an essential part in the diagnosis of prostate cancer. Although this procedure is well tolerated by most patients, sometimes it can result in some uneasiness. In this randomised double-blind placebo controlled study, we evaluated the effectiveness of intrarectal lidocaine during TRUS guided biopsy. MATERIALS AND METHODS: 100 consecutive eligible patients who had elevated total prostate specific antigen (tPSA) and/or abnormal digital rectal examination (DRE) were included into this study. Patients were randomised into two groups. Group I received 20 cc of 2% intrarectal lidocaine 20 minutes before transrectal ultrasound guided biopsy and Group II received same amount of serum physiologic. Pain was assessed using a 10 point modified visual analog scale. RESULTS: Mean patient age was 65.5+/-2.5 and 64.5+/-11.5 years, mean tPSA was 12.3+/-3.6 and 11.3+/-1.7 ng/ml, mean biopsy duration was 6.8+/-2.5 and 6.6+/-2.2 minutes, mean pain score during transrectal ultrasound guided biopsy was 4.8+/-2.2 and 4.4+/-2.1 in Groups I and II, respectively. No statistically significant difference was observed with respect to age, tPSA, mean biopsy duration and pain score between these groups. There was only one patient who could not tolerate the procedure at all, and he was paradoxically in the lidocaine group. CONCLUSION: The use of intrarectal lidocaine is not superior to placebo during transrectal prostate biopsy for pain control.     

Randomized trial of lidocaine vs lidocaine/bupivacaine periprostatic injection on longitudinal pain scores after prostate biopsy

PURPOSE: Periprostatic lidocaine reduces immediate post-prostate biopsy pain but still many men will not consent to re-biopsy. We performed a randomized study to assess whether adding long acting local anesthesia to a short acting agent would further reduce pain. MATERIALS AND METHODS: A total of 300 men undergoing transrectal ultrasound guided prostate biopsy were sequentially randomized to receive either short acting local lidocaine (lid) or short and long acting lidocaine and bupivacaine (lid/bup). A 7-day questionnaire was used to study daily pain (10-point visual analog score), bleeding (hematuria, PR bleeding, hematospermia), visits to the family doctor and analgesic use, and whether they would agree to future re-biopsy. RESULTS: Of the 256 questionnaires returned 250 were suitable for analysis. Cross-sectional comparison showed no intergroup differences in mean pain scores immediately after biopsy (2.24, 95% CI 1.94-2.5 vs 2.61, 95% CI 2.3-2.9, p = 0.88 in lid and lid/bup groups, respectively). There was a significant rebound in visual analog scale at 1 hour in the lid group but not in the lid/bup group (+ 0.9 vs + 0.09, p = 0.0006). Longitudinal analysis showed the global pain experience after lid/bup was better compared to lidocaine alone, with significantly less pain every subsequent day (p = 0.0006 to 0.002). No difference was seen in morbidity, analgesia usage or number refusing future re-biopsy (9.6% vs 9.8%). CONCLUSIONS: Long and short acting local anesthetics together significantly attenuate the 1-hour rebound increase in pain scores seen after short acting anesthesia alone. Improved pain scores were sustained during the subsequent week and we advocate routine combination use for transrectal ultrasound guided prostate biopsy.     

Effect of intraprostatic local anesthesia during transrectal ultrasound guided prostate biopsy: comparison of 3 methods in a randomized, double-blind, placebo controlled trial

PURPOSE: We evaluated the effect of intracapsular anesthesia and periprostatic nerve block during transrectal ultrasound guided prostate biopsy. MATERIALS AND METHODS: In a prospective, randomized, double-blind, placebo controlled study 152 consecutive patients were randomized into 3 groups. Group 1 of 41 patients was administered intraprostatic local anesthesia into the right and left sides with a total of 2 ml 1% lidocaine and a periprostatic injection of 2 ml saline later. Group 2 of 49 patients was administered intraprostatic injection of 2 ml saline, followed by periprostatic local anesthesia with 2 ml 1% lidocaine. Group 3 of 62 patients received intraprostatic and periprostatic local anesthesia with 2 ml 1% lidocaine. Patients were asked to grade the pain level using a 10-point linear visual analog pain scale 1) when the transrectal ultrasound probe was inserted, 2) during anesthesia, 3) during biopsy and 4) 20 minutes after biopsy. One-way ANOVA and the Kruskal-Wallis test with the Tukey post hoc test were used to compare patient characteristics and pain scale responses among the 3 groups. RESULTS: No major complications, including sepsis and severe rectal bleeding, were noted in any patient. There were statistically significant differences in pain scores among groups 1 to 3 during anesthesia (mean +/- SD 5.6 +/- 2.5, 6.7 +/- 2.3 and 4.9 +/- 2.1, p = 0.003) and during biopsy (4.3 +/- 2.7, 4.5 +/- 2.6 and 2.7 +/- 2.1, respectively, p = 0.032). There were no differences in pain scores among the 3 groups during probe insertion (p = 0.39). CONCLUSIONS: A combination of intracapsular anesthesia and periprostatic nerve block is an effective and useful technique that is well tolerated by the patient. It decreases the level of pain and discomfort associated with the prostatic biopsy procedure.     

A randomized prospective trial of intrarectal lidocaine for pain control during transrectal prostate biopsy: the Emory University experience

PURPOSE: We prospectively evaluated the safety and efficacy of intrarectal lidocaine gel as anesthesia during transrectal prostate biopsy. MATERIALS AND METHODS: Of 63 consecutive men undergoing transrectal prostate biopsy 50 who qualified were enrolled in this study. Indications for the procedure were an abnormal prostate on digital rectal examination and/or elevated serum prostate specific antigen. Patients were randomized into group 1-25 who received 10 cc of 2% intrarectal lidocaine 10 minutes before the procedure and group 2-25 controls. No narcotics, sedation or analgesia was given. Pain during biopsy was assessed using a 10-point linear visual analog pain scale. RESULTS: In groups 1 and 2 median patient age was 63 and 66 years (p = 0.139), and median prostate specific antigen was 6.04 (range 1.07 to 263) and 7.24 (range 1.34 to 51.82) ng./ml. (p = 0.337). Digital rectal examination was normal and abnormal in 17 and 15 group 1, and in 8 and 10 group 2 patients, respectively. Ultrasound showed a median prostate volume of 43.6 cc (range 15.3 to 124) in group 1 and 40.3 (range 19.8 to 132) in group 2 (p = 0.710). Final histological results revealed prostate cancer in 7 men (28%) in each group. The median pain score during transrectal prostate biopsy was 2 (range 1 to 5) and 5 (range 1 to 7) in groups 1 and 2, respectively (p = 0.00001). No adverse events were noted. CONCLUSIONS: Intrarectal lidocaine gel is a simple, safe and efficacious method of providing satisfactory anesthesia in men undergoing transrectal prostate biopsy. We recommend its routine administration in all patients during this procedure.     

Tolerability of prostate transrectal biopsies using gel and local anesthetics: results of a randomized clinical trial

PURPOSE: To evaluate the role of intrarectal EMLA, a new topical anesthetic cream, and lidocaine gel as local anesthesia during transrectal prostate biopsy and to observe whether gel temperature can improve pain control. PATIENTS AND METHODS: A series of 210 consecutive patients were randomized. Group 1 (N = 60) underwent intrarectal instillation of EMLA cream, group 2 (N = 50) 2.5% lidocaine gel, group 3 (N = 40) placebo, and group 4 (N = 60) no treatment. Patients in groups 2 and 3 were subdivided into subgroups according to instillation of warm or cooled gel. Pain control was assessed by a 10-point visual analog scale. RESULTS: The median pain scores were 2.6 in group 1, 3.8 in group 2, 3.9 in group 3, and 3.6 in group 4. In 16 patients (7.6%), the procedure was suspended because of pain: none group 1, 6.0% in group 2, 10% in group 3, and 15% ing group 4. The temperature of the lidocaine gel did not affect tolerability. Conclusion: Intrarectal instillation of EMLA cream is a simple, safe, and effective method of local anesthesia during transrectal prostate biopsy, superior to lidocaine gel, placebo, and no treatment.     

Nitrous oxide inhalation to improve patient acceptance and reduce procedure related pain of flexible cystoscopy for men younger than 55 years

PURPOSE: Flexible cystoscopy in men younger than 55 years is painful despite the current best standard anesthesia (20 ml 2% lidocaine gel 15 minutes before endoscopy). The anesthetic value of lidocaine gel is debated and led us to seek an alternative. Nitrous oxide is a well established analgesic and anxiolytic agent, and it significantly reduces pain associated with transrectal ultrasound guided prostate biopsy. We studied its use in flexible cystoscopy in men younger than 55 years. MATERIALS AND METHODS: A total of 61 patients were prospectively randomized to receive air (31) or Entonox (30). Both groups had 3 minutes of gas via a breath activated facemask (either Entonox or air) before endoscopy. The gel control group was comprised of 8 patients who underwent cystoscopy after instillation of lidocaine gel. The air and Entonox groups had lidocaine gel as per best standard. Vital signs were recorded before, during and after cystoscopy. Patients completed a visual analog score for gel insertion and cystoscopy. RESULTS: There were no statistically significant differences between the groups in terms of baseline characteristics. Pain scores for cystoscopy (p<0.001) and intraoperative pulse rate (p=0.008) were significantly less with Entonox. Side effects were transient and seen more often with Entonox (p<0.05). More of the air group would require more analgesia (p=0.001) or a general anesthetic (p=0.011) if undergoing repeat cystoscopy. CONCLUSIONS: Nitrous oxide inhalation significantly reduces cystoscopy related pain without significant complications. We propose that Entonox should be the anesthetic agent of choice for men younger than 55 years.     

Nitrous oxide vs periprostatic nerve block with 1% lidocaine during transrectal ultrasound guided biopsy of the prostate: a prospective, randomized, controlled trial

PURPOSE: We compared the efficacy of Entonox (BOC Gases, Manchester, United Kingdom), a mixture of 50% nitrous oxide and oxygen, with periprostatic infiltration of 1% lidocaine to provide analgesia during transrectal ultrasound (TRUS) guided biopsy of the prostate. MATERIALS AND METHODS: The study included 235 consecutive men undergoing TRUS guided biopsy of the prostate for elevated prostate specific antigen or abnormal digital rectal examination. Patients were randomized to 3 groups, including group 1-84 controls who did not receive any form of analgesia prior to the procedure, group 2-75 who received periprostatic infiltration with 10 ml 1% lidocaine with biopsies performed 5 minutes after infiltration and group 3-76 who received Entonox for 2 minutes through a breath activated device prior to the procedure and thereafter according to patient preference. All patients were asked to indicate the level of pain experienced before and after the procedure on a 10 cm, nonnumerical, horizontal visual analog score. Results were analyzed using 1-way ANOVA. RESULTS: Mean patient age was 68.8, 64.9 and 65.2 years, and mean visual analog score was 2.9, 1.6 and 2.2 in groups 1 to 3, respectively. Patients in groups 2 (1% lidocaine infiltration) and 3 (Entonox) experienced significantly less pain during the procedure compared with group 1 controls (p <0.001 and 0.028, respectively). There was no statistical difference in pain scores between groups 2 and 3 (p = 0.08). CONCLUSIONS: Inhalation of Entonox or periprostatic infiltration with 1% lidocaine can be used for analgesia during TRUS guided biopsy of the prostate since each provides significant and similar pain relief.     

Comparison of lidocaine suppositories and periprostatic nerve block during transrectal prostate biopsy

The aim of this randomized prospective and partially double-blind study was to evaluate the efficacy of transrectal lidocaine applied as suppositories in comparison to periprostatic infiltration as methods of reducing pain during transrectal prostate biopsy. 100 patients were randomized to four groups and received either a suppository containing 60 mg of lidocaine 2 h before biopsy, a 120-mg lidocaine suppository 1 h before biopsy, a 120-mg lidocaine suppository 2 h before biopsy, or they were anaesthetized with a periprostatic infiltration of 5 ml 2% lidocaine. In all patients the same 10-core transrectal biopsy technique was performed. Pain was evaluated using a visual pain scale ranging from 0 to 10 points. The mean pain score in the 60-mg (2 h), 120-mg (1 h), and 120-mg (2 h) lidocaine suppository groups was 3.63, 3.56, and 3.58 respectively. The mean pain score of patients receiving periprostatic infiltration was 1.80. No patient showed vegetative symptoms like sweating or hypotonia. No patient had severe pain. Eight of the 9 patients with no pain were in the periprostatic injection group. Thus, all lidocaine suppositories showed a good analgesic effect although a significantly better pain reduction was achieved by periprostatic lidocaine infiltration.     

Periprostatic local anesthesia before ultrasound guided prostate biopsy

PURPOSE: We assessed the morbidity and benefit of periprostatic local anesthesia administered before ultrasound guided prostate biopsy. MATERIALS AND METHODS: After placing the transrectal ultrasound probe and visualizing the prostate 50 consecutive patients received local anesthesia before prostate biopsies. RESULTS: There was no morbidity associated with the infiltration of local anesthesia into the periprostatic neurovascular plexus. Only 1 patient had discomfort during prostate biopsies, and 10 patients who previously underwent biopsies without anesthesia commented favorably on the dramatic difference. CONCLUSIONS: Many patients have pain during transrectal ultrasound guided biopsies of the prostate and few clinicians provide a periprostatic nerve block before this procedure. A periprostatic nerve block administered before the biopsies dramatically decreases discomfort. We urge all urologists to attempt this procedure, and we are confident that they will adopt it as part of their practice.     

利多卡因预防超声引导经直肠前列腺穿刺活检术疼痛:一项单中心、前瞻性、随机单盲、安慰剂对照临床试验

目的 评价利多卡因预防超声引导经直肠前列腺穿刺活枪术疼痛的有效性和安全性.方法 采用随机化分组方法,将1 80例行经直肠超声引导前列腺穿刺活检术的患者,随机分为试验组(利多卡因组)、生理盐水组(安慰剂生理盐水组)与空白对照组(不使用任何药物),每组60例.试验组患者经直肠在前列腺与精囊连接部两侧各注射2%利多卡因各5ml;生理盐水组注射生理盐水;空白对照组直接行穿刺活检.采用视觉模拟评分尺(VAS)分别在B超探头进入直肠、麻醉术毕、穿刺术毕、穿刺术后20min四个评分点进行疼痛评分,穿刺结束时及术后一周随访评判患者有无并发症及其程度.在临床试验过程中对前列腺穿刺术者、VAS评分操作者、数据评价者与患者实施盲法.结果 在四个评分点对三组患者进行疼痛评分,试验组患者疼痛评分分别为(1.085±1.438)、(1.698±1.708)、(2.030±1.877)、(0.972±1.111),生理盐水组分别为(1.062±1.049)、(2.75 3±2.345)、(3.992±2.406)、(1.020±0.731),空白对照组分别为(0.903±0.901)、(0.088±0.240)、(3.495±1.885)、(1.160+1.094).超声探头进入直肠与穿刺术后20min评分比较差异无统计学意义(P值均0.05);麻醉术毕疼痛评分各组比较差异有统计学意义(P＜0.0001),试验组与生理盐水组、空白对照组比较差异有统计学意义(P值均＜0.05);穿刺术毕疼痛评分各组比较差异有统计学意义(P＜0.0001),试验组与生理盐水组、空白对照组比较差异有统计学意义(P值均＜0.01).3组患者对镇痛效果的满意度分别为91.667%、76.667%与58.333%,各组比较差异有统计学意义(P=0.0001).所有患者除空白对照组发生1例败血症外,均未见严重血管迷走神经反射、严重感染、严重直肠出血、严重血尿及尿潴留并发症.各组并发症的发生比较差异均无统计学意义(P值均＞0.05).无患者出现局麻药中毒症状、尿潴留等并发症.所有患者均完成一周随访,随访期间无严重并发症发生.结论 穿刺术前在前列腺基底部与精囊连接部两侧注射盐酸利多卡因注射液,能显著降低穿刺术中、术后的疼痛程度,具有较好的疗效和安全性.推荐在前列腺穿刺活检术前常规应用.     

Comparison of 3 different methods of anesthesia before transrectal prostate biopsy: a prospective randomized trial

PURPOSE: Periprostatic nerve block (PNB) is the most common anesthesia technique used before prostate biopsy. However, needle punctures for anesthetic infiltration may be painful and cause higher infectious complications. We assessed whether addition of rectal lidocaine gel would improve its efficacy. We also investigated the efficacy and safety of tramadol, a codeine derivative, as a noninvasive method. MATERIALS AND METHODS: A total of 300 patients who underwent prostate biopsies were randomized into 4 groups of controls, PNB, perianal/intrarectal lidocaine gel plus PNB and tramadol. Pain was assessed with a numeric analog scale. RESULTS: Each group consisted of 75 patients, and there was a statistically significant difference among pain scores (p = 0.001). Mean pain scores were 4.63 for controls, 2.57 for PNB, 2.03 for infiltration plus gel group and 3.11 for tramadol. Pain and discomfort were least in PNB plus gel arm. The difference of pain score between PNB alone and tramadol group did not reach statistical significance. Infectious complications were higher in the combination group, whereas there were no complications with tramadol. CONCLUSIONS: Any form of analgesia/anesthesia was superior to none. The combination of PNB plus gel provided significantly better analgesia compared to PNB alone or tramadol. If this can be duplicated in other trials, the combination may be accepted as the new gold standard of anesthesia for prostate biopsy. The efficacy of tramadol was similar to that of PNB, and was free of complications. Therefore, tramadol may have a role before prostate biopsy, which needs to be explored.     

The Optimum Doses of and Injection Locations for Periprostatic Nerve Blockade for Transrectal Ultrasound Guided Biopsy of the Prostate: A Prospective,Randomized, Placebo Controlled Study

PurposeWe evaluated the efficiency of various amounts of local anesthesia and various numbers of injection sites to determine the most effective pain control with the least number of injections and the amount of injected medium in patients who underwent transrectal ultrasound guided prostate biopsy.Materials and MethodsTransrectal ultrasound guided 8 core biopsy of the prostate was performed in 175 consecutive men. Patients were randomized into 7 groups with 25 per group. Group 1 received 5 cc saline and groups 2 to 7 received 2.5, 5 or 10 cc 1% lidocaine injected as local anesthesia at basal or basal plus apical locations. The patients were then evaluated for pain and other complications to determine whether there was a difference regarding groups.ResultsMean pain scores were significantly lower than in saline group for all anesthesia injected groups except group 2 with a 2.5 cc bilateral basal injection. The most effective pain control was achieved by 10 cc anesthetic injections. Basal plus apical injections were not superior than only basal injections for pain control. There was no significant difference in the hematuria, hematospermia, rectal bleeding or infection rate among the groups. Increasing the number of injections and amount of lidocaine had no effect on complication rates.ConclusionOur placebo controlled, prospective, randomized study indicated that 10 cc local anesthetic injections supply significantly better pain control than lower doses for periprostatic nerve blockade during prostate biopsy. Although bilateral basal plus apical 10 cc lidocaine injections resulted in the lowest mean pain score, there was no statistically significant difference from 10 cc bilateral basal injections.