利多卡因局部麻醉在经直肠超声引导前列腺穿刺活检术中的临床应用

目的　评价利多卡因局部麻醉在经直肠超声引导前列腺穿刺活检术中的安全性。　方法　经直肠超声引导前列腺 10针穿刺活检术患者 15 0例 ,均因排尿困难就诊。随机分成 3组 ,每组5 0例。第 1组经直肠在前列腺尖部及两侧前列腺精囊连接部注射 1%利多卡因各 3ml;第 2组注射生理盐水 ;第 3组为对照组 ,直接行穿刺活检。穿刺结束时采用视觉模拟评分尺 (VAS)对穿刺过程进行疼痛评分 ;穿刺结束时及术后第 7天评判患者有无并发症及其程度。　结果　利多卡因组、生理盐水组及对照组疼痛评分分别为 1.96、3.98和 3.70 ,利多卡因组疼痛明显减轻 (P <0 .0 5 ) ,生理盐水组与对照组差异无显著性意义 (P >0 .0 5 )。利多卡因组术后无感染发生 ,直肠出血量 (3.96± 0 .39)ml,肉眼血尿发生率 76 % (38/ 5 0 ) ,排尿困难加重发生率 12 % (6 / 5 0 ) ,尿潴留发生率 2 % (1/ 5 0 ) ,轻度血管迷走神经反射发生率 10 % (5 / 5 0 ) ,与生理盐水组和对照组比较 ,差异均无显著性意义 (P >0 .0 5 )。　结论　前列腺尖部及两侧前列腺精囊连接部注射利多卡因局部麻醉 ,能显著降低穿刺过程中的疼痛及不适程度 ,不增加术中及术后并发症 ,推荐在经直肠前列腺穿刺活检术中常规应用。     

如何减少经直肠B超引导下前列腺穿刺活检的疼痛：文献评述

经直肠B超（TRUS）引导下前列腺穿刺活检疼痛的产生机理有2种：超声探头插入直肠时造成盲肠不适，穿刺针穿入前列腺产生疼痛。因直肠壁对痛觉不敏感，故以穿刺针穿过前列腺包膜刺激包膜上的感觉神经受体产生的疼痛为主。减少穿刺活检过程中疼痛的方法：前列腺周同神经阻滞PNB（利多卡因、布比卡因等，不同注射途径）、麻醉胶剂（利多卡因凝胶等）、镇静药物（一氧化二氮-氧混合气、异丙酚）及其他方法（岁非考昔、双氯芬酸、     

利多卡因局部麻醉在经直肠前列腺穿刺活检术中的应用

目的　评价利多卡因局部麻醉在超声引导经直肠前列腺穿刺活检术中的有效性和安全性。　方法　 150例PSA升高和 (或 )DRE异常和 (或 )TRUS异常患者接受超声引导经直肠前列腺10针穿刺活检术 ,随机分成 3组 ,每组 50例 ,第 1组在尖部及两侧的前列腺精囊连接部注射 2 %利多卡因 ,每点 3ml,第 2组注射生理盐水 ,第 3组为对照组 ;穿刺结束后即刻对患者进行VAS疼痛评分。　结果　利多卡因组疼痛评分 0～ 7.5分 ,平均 2 .0分 ;生理盐水组 0～ 9.1分 ,平均 4.0分 ;对照组 0～ 7.4分 ,平均 3 .7分。经方差分析检验 ,利多卡因组与生理盐水组及对照组差异有显著性意义 (P <0 .0 5) ,后两组间差异无显著性意义 (P >0 .0 5) ,利多卡因组疼痛程度低于生理盐水组与对照组。 150例患者观察 6～ 10d ,无并发症发生。　结论　利多卡因局部麻醉操作简便 ,安全有效 ,能显著降低患者术中的疼痛感觉 ,推荐为超声引导经直肠前列腺穿刺活检术中常规应用方法     

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.     

奥布卡因表面麻醉和利多卡因局部阻滞麻醉对经直肠前列腺穿刺术疼痛控制的比较

目的比较奥布卡因、利多卡因两种不同应用方式:表面麻醉和局部阻滞麻醉,对于经直肠前列腺穿刺术中疼痛的控制效果。方法将符合前列腺穿刺指征的患者共120例随机抽签分为两组,分别是表面麻醉组(表面组)和局部阻滞组(阻滞组),两组均通过相同方式行经直肠前列腺穿刺活检,术后通过视觉模拟评分(VAS)进行疼痛评分。同时比较两组的手术时间,手术后并发症发生率。结果表面组术后疼痛评分平均为4.84±1.48,阻滞组术后疼痛评分平均为3.87±1.22,两组统计学无明显差异(P0.05)。手术时间表面组明显小于阻滞组。穿刺术后并发症无明显差异。结论奥布卡因表面麻醉和利多卡因局部阻滞麻醉对经直肠前列腺穿刺的术中疼痛控制无明显差异,而表面麻醉操作更简便,且可有效缩短手术时间。     

局部浸润麻醉与黏膜表面麻醉在经直肠超声引导前列腺穿刺活检中的应用比较

目的比较前列腺局部浸润麻醉与直肠黏膜表面麻醉在经直肠超声引导前列腺穿刺活检中应用的安全性和有效性。方法将2018年3月至8月中山大学附属第三医院拟行前列腺穿刺活检的疑似前列腺癌患者纳入本研究,前瞻性随机分成两组。实验组采用超声引导下利多卡因于前列腺基底部和精囊腺间交角周围的血管神经束进行局部浸润麻醉;对照组采用利多卡因凝胶直肠黏膜表面麻醉。收集患者穿刺前后基线特征及穿刺后VAS评分、穿刺前后膀胱残余尿、穿刺阳性率、Gleason评分及血尿等相关并发症进行比较。结果共66例患者纳入本研究。穿刺过程中实验组疼痛评分低于对照组。两组间穿刺阳性率、Gleason评分、残余尿、尿潴留、肉眼血尿、发热等没有组间差异。结论局部浸润麻醉比直肠黏膜表面麻醉更能明显缓解经直肠超声引导前列腺穿刺的疼痛,对穿刺阳性率无明显影响,是更安全有效的麻醉方法,但需要一定经验的超声医师引导。     

丁卡因胶浆在经直肠前列腺穿刺活检中的临床应用价值

目的 比较患者在行经直肠前列腺穿刺活检术时,在直肠内及肛周使用丁卡因胶浆或单纯润滑剂,患者所经历的疼痛情况.方法 回顾性分析2011年1月至2013年1月120例行经直肠前列腺穿刺患者的临床资料.其中术中采用单纯性润滑剂患者60例（组Ⅰ）,采用丁卡因胶浆患者60例（组2）.采用水平视觉疼痛评分法评估患者经历的疼痛程度.结果 通过组间比较,两组患者疼痛程度与患者年龄、PSA水平、DRE是否异常、穿刺数目及术后并发症发生等均无统计学意义（P＞0.05）,当穿刺器械进入肛门时患者疼痛不适评分组1为2.8±1.8分,组2为1.3±1.6分（P=0.000＜0.05）,当行前列腺穿刺活检术时患者疼痛不适评分组1为5.5±1.7分,组2为3.3±1.5分（P=0.211 ＞0.05）.结论 麻药制剂并不能增加经直肠前列腺穿刺活检术的安全性,但采用麻药制剂（如丁卡因胶浆）后可明显减轻穿刺所带给患者的疼痛不适.     

利多卡因加布比卡因局部麻醉在前列腺穿刺活检术中的应用

目的探讨经直肠前列腺穿刺活检引起的疼痛规律，评价利多卡因加布比卡因局部麻醉的镇痛效果及安全性。方法经直肠行前列腺10针穿刺活检患者150例，随机分3组，每组50例，A组在尖部、两侧的前列腺体部与直肠壁间注入利多卡因加布比卡因复合剂（质量浓度为1％利多卡因、0．2％布比卡因、1：20万单位肾上腺素）各3ml，B组在相同位置注射1％利多卡因，C组直接行穿刺活检。对患者术中及术后1周内的疼痛行视觉模拟评分尺评分。结果A、B、C组术中疼痛评分分别为2．2±1．5、2．0±1．5、3．5±1．9，P〈0.01；术后1h疼痛评分分别为2．2土1．3、3．1±1.1、2．8±1．4，P〈0．01；术后1d分别为1．7±1.1、1.8±1．1、1．7±1．3，P〉0.05；术后6d均为0．2土0．5，P〉0.05。A组2例患者出现术后寒战高热，C组1例术后当晚出现低热。术后A、B、C组分别有1、3、4例患者需口服止痛药。结论经直肠前列腺穿刺活检引起的疼痛主要在术中及术后1d之内。联合应用利多卡因加布比卡因局部麻醉能显著降低患者术中、术后的疼痛程度，并能消除单用利多卡因麻醉引起的术后疼痛反弹现象。     

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.     

老年男性静脉麻醉下经直肠超声引导无痛前列腺穿刺疼痛控制与并发症分析

目的：探讨前列腺特异抗原增高（PSA〉4/μg/L）老年男性静脉麻醉下经直肠超声引导无痛前列腺穿刺疼痛控制与并发症发生情况.方法：选取96例PSA增高老年男性患者（69±7岁）进行静脉麻醉下直肠超声引导无痛前列腺12针系统穿刺（静脉麻醉组）,并选取同期进行前列腺周围神经阻滞麻醉下直肠超声引导前列腺12针系统穿刺的51例PSA增高老年男性患者（67±6岁）为对照组.记录穿刺后30 min视觉模拟疼痛评分（VAS）、穿刺时间、麻醉不良事件和并发症发生情况.结果：静脉麻醉组90例（94%）为无疼痛（VAS=0）,6例（6%）为轻度疼痛 对照组21例（41%）为轻度疼痛,30例（59%）为中度疼痛.静脉麻醉组平均VAS评分和穿刺时间分别为（0.1±0.3）分和（5.1±1.3）min,显著低于对照组（3.85±1.2）分和（11.35±3.9）min.静脉麻醉组无一例发生麻醉不良事件.静脉麻醉组术后肉眼血尿、大便带血、发热和尿潴留的发生率分别为55%、15%、5%和3%,与对照组的差异无统计学意义（57%、18%、6%和4%）.结论：对于PSA增高老年男性患者,静脉麻醉直肠超声引导无痛前列腺穿刺具有无痛安全准确的优点.     

Rectal Sensation Test Helps Avoid Pain of Apical Prostate Biopsy

PurposeApical cores obtained during transrectal prostate biopsy are associated with greaterpain than cores obtained from the remainder of the gland. We present a method to minimize this pain.Materials and MethodsDuring 30 consecutive apical biopsies the needle was purposefully placed above all rectal pain fibers, which are anatomically present only below the dentate line. All patients received a periprostatic nerve block prior to biopsy. The patient was asked if he felt the sharp sensation of the needle as it was placed lightly against the rectal mucosa when the needle was aimed at apex (the rectal sensation test). If so, the needle was advanced cranially 2 to 3 mm or until he could no longer detect its light touch. The probe handle was then rotated dorsally, pulling the rectal mucosa downward until the needle was again aimed at the apex. Patients were asked to report a visual analog pain score for each biopsy. These results were compared to those obtained when doing 30 consecutive apical biopsies without the rectal sensation test.ResultsThe average visual analog pain score for apical biopsy was 1.25 (range 0 to 2.2) for patients in whom the rectal sensation test was used to bypass rectal pain sensory fibers. The average score in control patients in whom the rectal sensation test was not used was higher at 2.28 (range 0.3–6.2). These results were statistically significant (p > 0.0005).ConclusionsIncreased sensitivity to apical prostate biopsy is due to rectal pain fibers located below the dentate line. These fibers and the associated pain may be safely avoided by passing through the rectal wall above the dentate line. The rectal sensation test easily identifies the sensate area below the dentate line. Painless apical biopsy can then be achieved by rotating the ultrasound probe to aim the biopsy needle in the desired path.     

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.     

Periprostatic local anesthesia eliminates pain of office-based transrectal prostate biopsy

Up to 96% of patient who undergo prostate biopsy report pain. We performed periprostatic local anesthesia injection in an effort to improve patient acceptance of prostate biopsy. Sixty patients were randomized to receive either local injection of lidocaine in the periprostatic nerves or no anesthetic. Lidocaine was injected through a 7-inch spinal needle placed through a transrectal ultrasound biopsy guide. Ten-core biopsies were immediately performed. Following biopsy, all patients gave a Visual Analog Scale (VAS) assessment of their pain experienced during biopsy.A majority of patients reported Visual Analog Scale (VAS) scores in the moderate (28.6%) or severe (28.6%) ranges unless local anesthesia was given. Only one of 27 patients (3.7%) receiving local anesthetic reported moderate pain, and none reported severe pain. Mean VAS pain scores were 1.4 in the anesthetic group and 4.5 in the control group (P<0.0001). No difficulty was encountered from scarring in the five patients who underwent nerve spring radical retropubic prostatectomy following local anesthetic injection. Periprostatic injection of local anesthetic essentially eliminates pain from prostate biopsy. Nerve-sparing radical retropubic prostatectomy is not more difficult as a result.     

Efficacy and cost analysis of transrectal ultrasound-guided prostate biopsy under monitored anesthesia

Sedation may result in reduction in pain during transrectal ultrasound (TRUS)-guided prostate biopsies. We aimed to evaluate the efficacy and safety of a combination of propofol and remifentanil infusion during TRUS-guided prostate biopsy and the related increases in health care costs. From January to September 2010, 100 men undergoing a transrectal prostate biopsy were randomized into two groups. In Group 1, 50 patients received a combined infusion of propofol and remifentanil; in Group 2, 50 patients received lidocaine jelly. After TRUS-guided biopsies were performed, pain and patient satisfaction were evaluated by a 10-point visual analog scale (VAS), and a cost-related patient satisfaction questionnaire was completed by all patients. Patients were also asked whether they would be willing to undergo repeat biopsy by the same method. Patients in Group 1 showed a significantly lower VAS score than those in Group 2 (mean VAS score: 0.9±1.1 versus 6.3±2.5; P<0.001). In addition, the patient satisfaction scale was significantly higher in Group 1 (P=0.002). Although the overall cost was significantly higher in Group 1 (P=0.006), patient satisfaction scales considering cost were also higher in this group (P=0.009). A combination of propofol and remifentanil is a safe and effective way to decrease patient pain and increase patient satisfaction during TRUS-guided prostate biopsy. Although the costs were higher in the group that received sedation, as expected, the patients exhibited heightened satisfaction and willingness to repeat biopsies by the same method.     

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.     

Topical prilocaine-lidocaine cream combined with peripheral nerve block improves pain control in prostatic biopsy: results from a prospective randomized trial

OBJECTIVES: To compare pain control results between periprostatic nerve block alone and combined with topical prilocaine-lidocaine cream as local anesthesia of prostate biopsy. METHODS: Three hundred patients were randomized to receive PNB (group 1), topical anesthesia of the anal ring, anal canal, and anterior rectal wall combined with PNB (group 2) and placebo (group 3). Patients were asked to use scale of 0-10 to complete a visual analogue scale questionnaire about pain during probe insertion (VAS1), periprostatic infiltration (VAS2), and cores (VAS3). RESULTS: Pain during probe insertion in group 2 was significantly less than in groups 1 and 3 (VAS1, 0.29 vs. 1.46 and 1.48; p<0.0001). Pain during periprostatic infiltration was also reduced in group 2 compared with group 1 (VAS2, 1.06 vs. 2.39; p<0.0001). Pain control was similar during biopsy in the PNB and combined groups (VAS3, 0.43 vs. 0.37; p=0.77) and was superior to group 3 (VAS3, 3.02; p<0.0001). In younger patients (cut off, median age 67 yr) these differences were still significant between groups 1 and 2 (VAS1, 1.95 vs.0.31; p<0.0001 and VAS2, 2.97 vs. 1,15; p<0.0001), but not in older patients (VAS1, 0.91 vs. 0.28; p=0.06; VAS2, 1.52 vs. 0,92; p=0.06). Vagal symptoms were registered in 36 (12%) patients in all groups. Sepsis occurred in one group 1 patient and in one group 2 patient. Rectal bleeding was observed in one group 2 patient. CONCLUSION: Combined prilocaine-lidocaine cream topically placed with PNB is superior to PNB alone and may be of maximum benefit for younger patients.     

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.