两种不同局麻方法在经直肠前列腺穿刺活检术中的镇痛效果比较

目的：比较经直肠超声引导前列腺神经阻滞术和直肠内灌注2％利多卡因凝胶在前列腺穿刺活检术中的镇痛疗效。方法：160例接受经直肠超声引导13点前列腺系统穿刺活检术的患者随机分为A、B两组。A组患者84例，在经直肠超声引导下，于前列腺基底部，左、右两侧精囊与前列腺交接处分别注射1％利多卡因5ml，B组患者76例，于活检前5min直肠内灌注2％利多卡因凝胶10ml。采用视觉模拟评分（VAS）评估两组患者在穿刺活检术中的疼痛程度。结果：两组患者在平均年龄（t=0．73）、PSA水平（t=0．34）和前列腺体积（t=0．55）的差异无显著性（P〉0．05），具有可比性。A组患者VAS评分0～3分者76例，4～5分者6例，6～10分者2例。B组患者则分别为48例、18例、10例。两组患者平均疼痛评分（VAS）分别为1．2分、2．6分，差异具有高度显著性意义（t=4．73，P〈0．01）。两组患者均未出现局麻药的不良反应。结论：经直肠超声引导前列腺神经阻滞术的镇痛疗效明显优于直肠内灌注2％利多卡因凝胶，值得临床推广应用。

Comparing 2 Methods of Local Anesthesia for Transrectal Ultrasound Guided Prostate Biopsy

Objective:To compare the clinical efficacy of transrectal ultrasound guided prostatic nerve blockade with intrarectal 2% lidocaine gel for pain control during transrectal prostate biopsy.Methods:160 patients receiving systematic 13 cores biopsy of the prostate were randomized into two groups.Group A(84 cases) received an injection of 5ml 1% lidocaine into the prostatic neurovascular bundles on each side at the base of the prostate under ultrasound guidance,and group B(76 cases) received 10 cc of intrarectal 2% lidocaine gel 5 minutes before the procedure.Pain during biopsy was assessed using a 10-point linear visual analog pain scale(VAS) immediately after this procedure.Results:The two groups were similar with respect to age,prostate-specific antigen level,and prostate olume.In group A,the VAS pain score of 0 to 3 was 76,4 to 5 was 6,6 to 10 was 2.In group B,the VAS pain score of 0 to 3 was 48,4 to 5 was 18,6 to 10 was 10.The mean pain scores during transrectal prostate biopsy were significantly lower in group A than group B((1.2) vs 2.6 t=4.73,P<0.01).During the study no patient in either group had any adverse effect from the injection.Conclusions:Transrectal ultrasound guided prostatic nerve blockade provides anesthesia superior to the intrarectal lidocaine gel during transrectal prostate biopsy.We recommend its routine administration in all patients during this procedure.