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OBJECTIVE@#To compare the efficacy of periprostatic nerve block (PPNB) alone versus periprostatic nerve block plus oral Tramadol+Paracetamol Tablet for pain control during and after transrectal ultrasound-guided (TRUS) biopsy of the prostate gland.@*METHODS@#This was a double-blind, placebo-controlled randomized clinical trial. The authors randomized 40 male patients each to either PPNB or PPNB plus oral tramadol and paracetamol (37.5mg/325mg) an hour prior to prostate biopsy. A ten-point visual analog scale was used to measure pain intensity and was recorded upon insertion of the ultrasound probe, during the biopsy, and one hour after the procedure.@*RESULTS@#The two groups were similar in terms of baseline characteristics. Reductions in pain scores were statistically significantly different (p<.001) for each group when comparing pain from at point of insertion of the probe versus during biopsy and versus one-hour post-operatively. However, when comparing the two groups, the pain scores were not statistically significantly different upon insertion of the probe (p=.68), during the biopsy (p=.26) and one-hour post-operatively (p=.54).@*CONCLUSION@#Tramadol and paracetamol combination in addition to periprostatic nerve block produces pain relief similar to standard periprostatic nerve block alone.
Subject(s)
Male , Prostate , Nerve Block , Biopsy , UltrasonographyABSTRACT
<p><b>Objective</b>To evaluate the analgesic effect of intrarectal local anesthesia (IRLA) versus that of periprostatic nerve block anesthesia (PPNB) in initial transrectal ultrasound-guided prostate biopsy (TRUS-PB) for patients with different prostate volumes (PV).</p><p><b>METHODS</b>A total of 253 patients undergoing initial TRUS-PB in our hospital from January 2014 to November 2017 were divided into three PV groups (<50 ml, 50－100 ml, and >100 ml), each again randomized into three subgroups (control, IRLA, and PPNB) with the random number table method. The pain during the procedure was assessed based on the Visual Analogue Scale (VAS) scores and the blind method was used by the biopsy operator, VAS valuator and data analyst.</p><p><b>RESULTS</b>Among the patients with PV <50 ml, the VAS scores in the blank control, IRLA, and PPNB subgroups were 4.39±0.87, 3.51±0.84 and 3.43±1.07, respectively, remarkably higher in the control than in the IRLA and PPNB groups (P<0.05), but with no statistically significant differences between the latter two (P>0.05). Among those with PV of 50－100 ml, the VAS scores in the three subgroups were 4.50±1.05, 4.38±1.13 and 3.38±1.44, respectively, markedly higher in the control and IRLA than in the PPNB group (P<0.05), but with no statistically significant differences between the former two groups (P>0.05). Among those with PV >100 ml, the VAS scores in the three subgroups were 5.19±1.05, 5.00±1.25 and 4.19±0.91, respectively, remarkably higher in the former two groups than in the latter (P<0.05), but with no statistically significant differences between the former two groups (P>0.05).</p><p><b>CONCLUSIONS</b>Either IRLA or PPNB can be recommended for initial TRUS-PB in patients with PV <50 ml, PPNB for those with PV of 50－100 ml, and PPNB with other painkillers for those with PV >100 ml.</p>
Subject(s)
Aged , Humans , Male , Administration, Rectal , Anesthesia, Local , Methods , Anesthetics, Local , Biopsy , Nerve Block , Methods , Pain Measurement , Pain, Procedural , Prospective Studies , Prostate , PathologyABSTRACT
Objective To investigate the influence factors of periprostatic nerve block (PNB) anaesthesia.Methods A total of 375 patients who underwent prostate biopsy under PNB were analyzed retrospectively from July 2014 to February 2018.It was evaluated the correlation of the anesthetic efficacy of PNB with age,prostate volume,PSA,body mass index,spouse,degree of education,occupation,diabetes history,operation time,number of cores and clinical stage.A visual analog scale (VAS) were used to assess pain of the patients.Univariate analysis was performed for each factor.Factors found to be significantly different that were further analyzed using multiple linear regression analysis.Results The average VAS score of all patients was 2.5 ± 1.4.Univariate analysis showed that the following factors were associated with the anesthetic efficacy of PNB:age (F =2.262,P =0.029),prostate volume (F =2.529,P =0.011),occupation (F =2.203,P =0.042),operation time (F =2.233,P =0.033),number of cores (F =2.401,P =0.016) and diabetes history (F =2.271,P =0.027).Multiple linear regression analysis showed that prostate volume (t =3.742,P ＜ 0.001),number of cores (t =4.252,P ＜ 0.001) and diabetes history (t =-2.242,P =0.032) were independent factors.The VAS score of patients with large volume prostate was higher than that of small volume prostate.The number of cores was high,and the VAS score was higher.However,diabetic patients had lower VAS score.Conclusions The anesthetic efficacy of PNB was poor in patients with larger prostate volume and more number of cores.However,patients with chronic diabetes had better pain tolerance.
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Objective To evaluate the anestheisa efficacy of periprostatic nerve block in transrectal ultrasound (TRUS) guided biopsy of the prostate.Methods A total of 223 patients received prostate biopsy in our hospital from July 2010 to December 2013 were retrospectively studied,and were divided randomly into two groups.One hundred and sixteen cases in nerve block group accepted local anesthesia of prostate capsule and periprostatic nerve block after local perineal skin anesthetia,and 107 cases in local anesthesia group only accepted local perineal skin anesthetia and local anesthesia of prostate capsule.Patients in the 2 groups underwent prostate biopsy successfully.The visual analogue scale (VAS) and complications were recorded.Results The age,serum PSA level before biopsy,prostate volume and the number of puncture needles had no significant differences between the 2 groups (P＞0.05).The average VAS score was 2.3± 1.1,and 4.9±2.3 in the 2 groups.The VAS had significant difference between the 2 groups (P＜0.05).The incidences of hematuria,hemospermia and urinary retention were 37.1％ (43/116),3.4％ (4/116) and 1.7％ (2/116) in nerve block group,and 39.3％ (42/107),4.7％ (5/107) and 1.9％ (2/107) in local anesthesia group.The difference was not significant (P＞0.05).Conclusion Periprostatic nerve block for TRUS guided biopsy of the prostate could be safe with good analgesic effect.
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Early prostate cancers are best detected with transrectal ultrasound (TRUS)-guided core biopsy of the prostate. Due to increased longevity and improved prostate cancer screening, more men are now subjected to TRUS-guided biopsy. To improve the detection rate of early prostate cancer, the current trend is to increase the number of cores obtained. The significant pain associated with the biopsy procedure is usually neglected in clinical practice. Although it is currently underutilized, the periprostatic nerve block is an effective technique to mitigate pain associated with prostate biopsy. This article reviews contemporary issues pertaining to pain during prostate biopsy and discusses the practical aspects of periprostatic nerve block.