[Comparative study between analgesic efficacy and safety of meperidine compared with lidocaine periprostatic infiltration in transrectal ultrasound guided prostate biopsy]. / Estudio comparativo entre la eficacia analgésica y seguridad de la meperidina intravenosa frente a la infiltración periprostática con lidocaína en biopsias transrectales de próstata.

OBJECTIVES: To assess the efficacy of intravenous analgesia with meperidine compared to periprostatic plexus infiltration with lidocaine, and safety of periprostatic local anesthesia. MATERIALS AND METHODS: A prospective randomized study with 100 patients undergoing first or second prostate biopsy. We distribute patients in two groups, group A (50 patients) which was administered 50 mg of intravenous meperidine and group B (50 patients) receiving 5 mL of lidocaine 2% in the angle between prostate and seminal vesicles. Pain was assessed by Visual Analog Scale (VAS) and a questionnaire about the emotional impact. Procedure safety was obtained by telephone questionnaire about prostate biopsy complications. The statistical analysis used was chi square test, Student's t test and Kruskal-Wallis no parametric test. RESULTS: Median age was 66 years (47-80) and both groups were homogeneous with regard to: PSA, prostate volume, core's number and educational level without significant differences. 74 patients (74%) had their first biopsy and 26 (26%) had their second one. The average number of core biopsy was 10,9 +/- 2, and VAS mean score for group A was 3,6 +/- 1,8 versus 3,2 +/- 2 Group B without significant differences (p>0,05). We found significant differences (p<0,05) between transducer introduction (3,9 +/- 1,9 group A/B group 4,3 +/- 2,2) and core biopsy (3,6 +/- 1,8 group A/B group 3,2 +/- 2,2). There were no differences between the data obtained with emotional impact test, age and educational level comparing to pain caused by prostate biopsy. Regard to the number of cores obtained there were no differences (p>0,05). Complications appeared in 12 patients (12%), 5 in the group of meperidine compared with 7 in the lidocaine without differences between them. CONCLUSION: Periprostatic plexus blocked with lidocaine does not offer advantages respect to meperidine, despite the fact that this is a safe method that does not increase the number of complications. Placing transrectal transducer causes more pain than biopsy cores.

Estudio comparativo entre la eficacia analgésica y seguridad de la meperidina intravenosa frente a la infiltración periprostática con lidocaína en biopsias transrectales de próstata / Comparative study between analgesic efficacy and safety of meperidine compared with lidocaine periprostatic infiltration in transrectal ultrasound guided prostate biopsy

Objetivo: Evaluar la eficacia de la analgesia intravenosa con meperidina frente a la infiltración del plexo periprostático con lidocaína, y seguridad de la anestesia local periprostática. Material y métodos: Estudio prospectivo aleatorizado con 100 pacientes sometidos a primera o segunda biopsia de próstata. Distribuimos a los pacientes en dos grupos; grupo A (50 pacientes) al que se le administra 50 mg de meperidina intravenosa y grupo B (50 pacientes) que reciben 5 mL de lidocaína al 2% en el ángulo prostatoseminal. El dolor fue evaluado mediante la Escala Analógico Visual (VAS) y un cuestionario a cerca del impacto emocional de la prueba. La seguridad del procedimiento se obtuvo mediante cuestionario telefónico sobre las complicaciones aparecidas tras la biopsia. Para el análisis estadístico se uso el test de chi cuadrado, la t de Student y test no paramétrico de Kruskal-Wallis. Resultados: La mediana de edad fue 66 años (47-80) siendo ambos grupos homogéneos respecto a: PSA, volumen prostático, número de cilindros y nivel de estudios, sin diferencias significativas. Se trató de una primera biopsia en 74 pacientes (74%) y 26 (26%) de una segunda. El número medio de cilindros fue de 10,9±2. La puntuación media del VAS para el grupo A fue 3,6±1,8 frente a 3,2±2 del grupo B sin diferencias significativas (p>0,05). Si comparamos el dolor con la introducción del transductor (grupo A 3,9±1,9 / grupo B 4,3±2,2) frente a la toma de cilindro (grupo A 3,6±1,8/grupo B 3,2±22) sí encontramos diferencias significativas (p<0,05). No se observan diferencias ente los datos obtenidos con el test de impacto emocional, la edad y el nivel de estudios frente al dolor producido por la prueba. Respecto al número de cilindros obtenidos tampoco existen diferencias (p>0,05). Aparecieron complicaciones en 12 pacientes (12%); 5 en el grupo de meperidina frente a 7 en el de lidocaína sin observar diferencias entre ambos. Conclusión: El bloqueo del plexo periprostático con lidocaína no ofrece ventajas analgésicas respecto a la meperidina, a pesar de que se trata de un método seguro que no aumenta el número de complicaciones. El paso del transductor transrrectal produce más dolor que la propia toma de los cilindros (AU)

Objectives: To assess the efficacy of intravenous analgesia with meperidine compared to periprostatic plexus infiltration with lidocaine, and safety of periprostatic local anesthesia. Materials and methods: A prospective randomized study with 100 patients undergoing first or second prostate biopsy. We distribute patients in two groups, group A (50 patients) which was administered 50 mg of intravenous meperidine and group B (50 patients) receiving 5 mL of lidocaine 2% in the angle between prostate and seminal vesicles. Pain was assessed by Visual Analog Scale (VAS) and a questionnaire about the emotional impact. Procedure safety was obtained by telephone questionnaire about prostate biopsy complications. The statistical analysis used was chi square test, Student’s t test and Kruskal-Wallis no parametric test. Results: Median age was 66 years (47-80) and both groups were homogeneous with regard to: PSA, prostate volume, core’s number and educational level without significant differences. 74 patients (74%) had their first biopsy and 26 (26%) had their second one. The average number of core biopsy was 10,9±2, and VAS mean score for group A was 3,6±1,8 versus 3,2±2 Group B without significant differences (p>0,05). We found significant differences (p<0,05) between transducer introduction (3,9±1,9 group A/B group 4,3±2,2) and core biopsy (3,6±1,8 group A/B group 3,2±2,2). There were no differences between the data obtained with emotional impact test, age and educational level comparing to pain caused by prostate biopsy. Regard to the number of cores obtained there were no differences (p>0,05). Complications appeared in 12 patients (12%), 5 in the group of meperidine compared with 7 in the lidocaine without differences between them. Conclusion: Periprostatic plexus blocked with lidocaine does not offer advantages respect to meperidine, despite the fact that this is a safe method that does not increase the number of complications. Placing transrectal transducer causes more pain than biopsy cores (AU)