Korean J Urol.  2012 Aug;53(8):547-551.

Comparative Evaluation of Periprostatic Nerve Block with and without Intraprostatic Nerve Block in Transrectal Ultrasound-Guided Prostatic Needle Biopsy

• Singh SK
• Kumar A
• Griwan MS
• Sen J

Abstract

PURPOSE
Controversy exists over the pain during prostate biopsy. Periprostatic nerve block is a commonly used anaesthetic technique during transrectal ultrasound (TRUS)-guided prostate biopsy. The recent trend toward increasing the number of cores has become popular. This practice further increases the need for a proper anaesthetic application. We compared the efficacy of periprostatic nerve block with or without intraprostatic nerve block.
MATERIALS AND METHODS
We conducted a prospective double-blinded placebo-controlled study at our institute with 142 consecutive patients. Patients were randomly assigned into 3 groups. Group 1 received periprostatic nerve block with intraprostatic nerve block with 1% lignocaine. Group 2 patients were administered periprostatic nerve block only with 1% lignocaine. Group 3 received no anaesthesia. Patients were asked to grade their level of pain by using an 11-point linear analogue scale at the time of ultrasound probe insertion, at the time of anaesthesia, during biopsy, and 30 minutes after biopsy.
RESULTS
The study groups were comparable in demographic profile, prostate-specific antigen (PSA) level, and prostate size. The mean pain scores at the time of biopsy in groups 1, 2, and 3 were 2.70, 3.39, and 4.16, respectively. Group 1 recorded the minimum mean pain score of 2.70 during prostate biopsy, which was significantly lower than the scores of groups 2 and 3 (p<0.001). There were no significant differences in pain scores among the 3 groups during probe insertion, during anaesthesia, or at 30 minutes after biopsy (p>0.05).
CONCLUSIONS
Periprostatic nerve block with intraprostatic nerve block provides better pain control than does periprostatic nerve block alone in TRUS-guided prostate biopsy.

Keyword

Analgesia; Lignocaine

MeSH Terms

Analgesia
Biopsy
Biopsy, Needle
Humans
Lidocaine
Needles
Nerve Block
Prospective Studies
Prostate
Prostate-Specific Antigen
Lidocaine
Prostate-Specific Antigen

Figure

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  FIG. 1 Patient characteristics. PSA, prostate-specific antigen.

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  FIG. 2 Results for mean pain scores. VAS, visual analogue scale.

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