Bulbul Muhammad A, Haddad Maurice C, Khauli Raja B, Hemady Kamal, Shaar Ahmad, Khouzami Riad, Wazzan Wassim
Department of Surgery, Division of Urology, Medical Center, American University of Beirut, P.O. Box 11-0236, Riad Solh, Beirut, Lebanon.
Clin Imaging. 2002 Mar-Apr;26(2):129-32. doi: 10.1016/s0899-7071(01)00365-5.
Transrectal ultrasound (TRUS)-guided prostate needle biopsy is the standard procedure to diagnose prostate cancer. It can be associated with significant discomfort and pain. We evaluated if periprostatic infiltration with local anesthetic reduces this discomfort.
72 patients underwent TRUS-guided prostate needle biopsy. All patients had 12 cores, with four prostatic zones of biopsies. In 25 consecutive patients (G1) with a median prostate size of 47 cc, no anesthesia was given; while in 47 sequential patients (G2) with a median prostate size of 50 cc, 2 ml of 2% lidocaine was infiltrated in the periprostatic area around the neurovascular bundle using 20-cm-long, 22-gauge needle on both sides as guided by color Doppler. Biopsies were performed in standard fashion. Discomfort was graded on a scale from 0 to 10 with 0 meaning no discomfort, 1-3 mild, 4-6 moderate, and 7-10 severe.
12/25 (48%) of G1 patients reported no discomfort compared to 70% in G2 (P=.025). Mild discomfort was reported in 5/25 (20%) patients of G1 and 9/47 (19%) patients of G2. Moderate or severe discomfort was reported in 8/25 (32%) patients and 5/47 (11%) patients in G2 (P=.039). Prostate size did not affect degree of discomfort within each group and between both subgroups. No adverse reactions were observed secondary to lidocaine infiltration.
Periprostatic infiltration with local anesthesia at the time of TRUS-guided prostate needle biopsy significantly reduces discomfort. It is easy to perform, safe, and should be considered in all patients irrespective of the prostate size.
经直肠超声（TRUS）引导下前列腺穿刺活检是诊断前列腺癌的标准方法。该方法可能会带来明显的不适和疼痛。我们评估了前列腺周围注射局部麻醉剂是否能减轻这种不适。
72例患者接受了TRUS引导下的前列腺穿刺活检。所有患者均穿刺12针，取材于前列腺的四个区域。连续25例（G1组）患者，前列腺中位体积为47立方厘米，未给予麻醉；后续47例（G2组）患者，前列腺中位体积为50立方厘米，在彩色多普勒引导下，使用20厘米长、22号穿刺针在双侧神经血管束周围的前列腺区域注射2毫升2%利多卡因。活检按标准方式进行。不适程度按0至10分进行分级，0分表示无不适，1 - 3分为轻度，4 - 6分为中度，7 - 10分为重度。
G1组中12/25（48%）的患者报告无不适，而G2组为70%（P = 0.025）。G1组5/25（20%）的患者和G2组9/47（19%）的患者报告有轻度不适。G1组8/25（32%）的患者和G2组5/47（11%）的患者报告有中度或重度不适（P = 0.039）。前列腺体积在每组内及两个亚组之间均不影响不适程度。未观察到利多卡因注射引起的不良反应。
TRUS引导下前列腺穿刺活检时在前列腺周围注射局部麻醉剂可显著减轻不适。该操作简便、安全，无论前列腺大小如何，所有患者均应考虑采用。
