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.

Comparison of three different methads of anesthesia during transrectal ultrasound guided prostate biopsy: a prospective, double-blind, randomized trial

Objective To assess the clinical efficacy and safety of three different methods of anesthesia during transrectal ultrasound guided prostate biopsy.Methods From July 2006 to October 2008,a total of 120 patients who underwent 12-core prostate biopsy with transrectal ultrasound guidance because of elevated prostate specific antigen and/or abnormal digital rectal examination were randomized into 4 groups,each group consisted of 30 patients.Group A received no anesthesia.Group B recevied an injection of 10 ml dose of 1%lidocaine(5 ml per side)into the region of the prostatic vascular pedicle at the prostate base just lateral to the junction between the seminal vesicle and prostate on each side for pefiprostatic nerve block (PNB).Group C received intrarectal lidocaine gel plus PNB.Group D received an injection of 4 ml dose of 1% lidocaine (2 ml per side) into 2 sites of the right and left sides of prostate for intraprostatic anesthesia plus PNB.The efficientcy of anesthesia was assessed by a visual analog pain scale (VAS).All patiens were followed up within one week for the evalution of complications.Results The combination of intraprostatic anesthesia and PNB provided significantly better pain control than PNB alone.According to VAS,only group C(2.7±1.1) scores showed significantly better pain control than other groups (P＜0.05)during probe insertion,and only group D(3.9±1.3)scores showed significantly better pain control than other groups (P＜0.05)during biopsy.No difference was observed regarding the complications rate in the 4 groups(P＞0.05).Conclusions Combination of intrapmstatic anesthesia and PNB is effective and safe technique during transrectal ultrasound guided prostate biopsy without increasing the incidence of complications.PNB or PNB plus intrarectal lidocaine gel couldn't significantly reduce pain during biopsy.