Pain control according to the periprostatic nerve block site in magnetic resonance imaging/transrectal targeted prostate biopsy

We analyzed the intensity of pain at each site of systemic prostate biopsy (SBx) and compared the intensity of pain among magnetic resonance (MRI)-targeted transrectal biopsies according to the periprostatic nerve block (PNB) site. We collected data from 229 consecutive patients who had undergone MRI-targeted biopsy. Patients were stratified into two groups according to the site of PNB (base versus base and apex PNB). Pain was quantified at the following time points: probe insertion, injection at the prostate base, injection at the prostate apex, MRI cognitive biopsy (CBx), MRI/transrectal ultrasound fusion biopsy (FBx), SBx, and 15 min after biopsy. For all biopsy methods, the average pain were significantly higher in the base PNB group than in the base and apex PNB group (CBx, p < 0.001; FBx, p = 0.015; SBx, p < 0.001). In the base and apex PNB group, FBx was significantly more painful than SBx (p = 0.024). Overall, regardless of the PNB site, pain at the anterior sites was more than that at the posterior sites in FBx (p = 0.039). Base and apex PNB provided better overall pain control than base-only PNB in all biopsy methods. In the base and apex PNB group, FBx was more painful than CBx and SBx.

Pain control according to the periprostatic nerve block site in magnetic resonance imaging/transrectal targeted prostate biopsy

INTRODUCTIONWe analyzed the intensity of pain at each site of systemic prostate biopsy (SBx) and compared the intensity of pain among magnetic resonance (MRI)-targeted transrectal biopsies according to the periprostatic nerve block (PNB) site.METHODSWe collected data from 229 consecutive patients who had undergone MRI-targeted biopsy. Patients were stratified into two groups according to the site of PNB (base versus base and apex PNB). Pain was quantified at the following time points: probe insertion, injection at the prostate base, injection at the prostate apex, MRI cognitive biopsy (CBx), MRI/transrectal ultrasound fusion biopsy (FBx), SBx, and 15 minutes after biopsy.RESULTSFor all biopsy methods, the average pain were significantly higher in the base PNB group than in the base and apex PNB group (CBx, p < 0.001; FBx, p = 0.015; SBx, p < 0.001). In the base and apex PNB group, FBx was significantly more painful than SBx (p = 0.024). Overall, regardless of the PNB site, pain at the anterior sites was more than that at the posterior sites in FBx (p = 0.039).CONCLUSIONSBase and apex PNB provided better overall pain control than base-only PNB in all biopsy methods. In the base and apex PNB group, FBx was more painful than CBx and SBx.

Pelvic Plexus Block Versus Periprostatic Nerve Block for Ultrasound-Guided Prostate Biopsy: A Meta-Analysis

BackgroundTo relieve prostate biopsy-related pain, various local anesthetic methods have been used. The best approach was periprostatic nerve block (PNB) in the past decade. Recently, pelvic plexus block (PPB) was employed to ultrasound-guided prostate biopsy. Compared with the PNB, the PPB may block a more extensive area. Therefore, PPB may be more effective in relieving prostate biopsy-related pain. However, several prospective randomized controlled trials (RCTs) comparing PPB and PNB drew conflicting conclusions, so we compared the difference of pain control between PPB and PNB for prostate biopsy.MethodsThe following databases were retrieved up to October 2020: PubMed, Chinese biomedicine literature database, the Cochrane Library, China National Knowledge Internet databases, Wan fang databases and Google Scholar. Only the RCTs were included. The main outcome measures were Visual Analog Scale (VAS) score and complications. The literature quality and extracted data were evaluated by two authors independently. The software Review Manager (version 5.3) was used to perform the data analysis that comparing the difference of VAS score and complications between PPB and PNB.ResultsAfter screening, six articles including 336 patients from PPB group and 337 patients from PNB group were performed meta-analysis in this study. The results showed that there were no significant difference of pain control in probe insertion and local anesthetic injection between PPB and PNB, while compared with PNB, patients with PPB experienced less pain during biopsy and 30 min after biopsy, respectively(MD = −0.57, 95% CI: −1.11 to −0.03, Z = 2.06, P = 0.04; MD = −0.21, 95% CI: −0.40 to −0.02, Z = 2.15, P = 0.03). In subgroup analysis, the pooled results showed that PPB was superior to PNB in 12-cores biopsy (pooled MD = −1.16, 95% CI: −1.61 to −0.71, P &lt; 0.00001), and more than 40-ml prostate size, regardless of transrectal or transperineal prostate biopsy. The reported major complications were urinary retention, hematuria, infection and hemospermia. The pooled results showed that there were no obvious difference in complications between PPB group and PNB group.ConclusionsOverall, this meta-analysis suggests that PPB provides safe and effective pain control of ultrasound-guided prostate biopsy, and PPB is superior to PNB. In future, it also needs more high quality, large samples RCTs to verify.

Comparative Study of Intraprostatic Infiltration With Lidocaine Injection and Periprostatic Nerve Block for Pain Free Trus Guided Prostate Biopsy

Objectives: To compare the efficacy of intraprostatic infiltration of lidocain injection and periprostatic nerve block for pain free TRUS guided prostate biopsies. Methods: A hospital based prospective experimental study was conducted in the Department of Urology of Dhaka Medical College Hospital, Dhaka from July 2007 to June 2009 to compare the different anesthesia technique for TRUS guided prostate biopsy for the detection of carcinoma prostate. All male patients aged over 55 years having lower urinary tract symptoms (LUTS) attending to urology OPD as well as in patient department were evaluated by history, physical examination including D/R/E and necessary investigations to identify the potential candidates for prostate biopsy and potential participants were counselled for prostate biopsy. Before taking biopsy patients were again judged by selection and exclusion criteria. Overall general examination as well as examination of urinary system and anorectal region was done. DRE was done to see the size, consistency and nodularity of prostate prior to biopsy. Who fulfilled the selection criteria included in this study in out patient basis or admitted in the urology ward and numbered chronologically, odd numbers for group-I includes periprostatic nerve block and even numbers for group-II includes intraprostatic infiltration of lidocain injection. They underwent 10 core prostate biopsy (standard 6 plus lateral 4 core) and hypoechoic lesion directed biopsy to see the unique cancer detection rate in each lobe. Data were analyzed using SPSS (Statistical package for social science) software program. The test of significance were chi-square, student t test, Fisher exact test, Mann Whitney test. Probability value (P Value<0.05) was considered significant. Results: Intensity of pain using visual analogue scale (VAS) demonstrates that the mean pain intensity during probe insertion was significantly less in Group-I than that in Group-II (5.8 ± 1.3 vs. 6.7 ± 1.3, p = 0.007). The mean pain intensity during anesthesia was also significantly less in the former group compared to the latter group (4.5 ± 1.2 vs. 5.1 ± 1.1, p = 0.036). Then the pain intensity of both the groups decreased, but the decrease was significantly faster and steeper in Group-II than in Group-I (p = 0.001). The pain intensity of Group-II 30 minutes after biopsy further decreased to 1.9 cm on visual analogue scale, while the pain intensity of Group-I increased from 4.1 cm during biopsy to 4.4 cm 30 minutes after biopsy (p < 0.001) . Results of the study revealed that -intraprostatic administration of local anesthesia significantly decreases the pain associated with prostate biopsy compared with conventional periprostatic nerve block. Conclusions: Intraprostatic administration of local anesthesia significantly decreases the pain associated with prostate biopsy compared with periprostatic nerve block. It is a simple, safe and rapid technique that should be considered in all patients undergoing transrectal ultrasound guided prostate biopsy Bangladesh Journal of Urology, Vol. 20, No. 2, July 2017 p.87-93