Stirling Brian N, Shockley Kenneth F, Carothers George G, Maatman Thomas J
Department of Urology, Michigan State University-College of Osteopathic Medicine Urologic Consortium, Metropolitan Hospital of Grand Rapids, Grand Rapids, Michigan 49546, USA.
Urology. 2002 Jul;60(1):89-92. doi: 10.1016/s0090-4295(02)01671-0.
To compare the effectiveness of periprostatic nerve blockade versus intrarectal lidocaine during transrectal ultrasound-guided biopsies.
A prospective randomized study was performed on 150 men requiring biopsy of the prostate. Patients were assigned to three groups: group 1 received no anesthetic, group 2 received 10 mL of 2% lidocaine gel intrarectally, and group 3 received a periprostatic injection of 5 mL of 1% lidocaine solution before undergoing prostate biopsy. Patients were asked to respond to a preprocedural and postprocedural questionnaire that consisted of four questions designed to evaluate pain perception and pain experienced, respectively, during the entire procedure.
The mean pain scores, comparing responses from groups 2 (topical lidocaine) and 3 (periprostatic) individually with those from group 1 (control), were not statistically different for any of the preprocedural questions. The postprocedural pain scores were significantly lower in groups 2 and 3 compared with those from group 1 (control) for overall procedure impression (3.1 +/- 1.7 and 2.6 +/- 1.8 versus 3.8 +/- 1.8, respectively; P <0.05 for both). The postprocedural scores for probe insertion were significantly lower for the topical group than for the control group (2.2 +/- 1.7 versus 3.7 +/- 2.1, P <0.05) but not for the periprostatic group compared with the control group (3.0 +/- 1.9, P = 0.14). The biopsy postprocedural scores were significantly lower for the periprostatic group than for the control group (2.8 +/- 1.9 versus 4.3 +/- 1.7, P <0.05).
Our data confirm that both techniques of local anesthesia are effective in reducing patient discomfort; however, periprostatic nerve blockade using injectable lidocaine appears to be more specific in reducing pain during the biopsy portion of the procedure.
比较经直肠超声引导下前列腺穿刺活检时前列腺周围神经阻滞与直肠内利多卡因的效果。
对150名需要进行前列腺穿刺活检的男性进行前瞻性随机研究。患者被分为三组：第1组未接受麻醉，第2组经直肠接受10 mL 2%利多卡因凝胶，第3组在进行前列腺活检前接受前列腺周围注射5 mL 1%利多卡因溶液。要求患者回答一份操作前和操作后的问卷，该问卷由四个问题组成，分别旨在评估整个操作过程中的疼痛感知和经历的疼痛。
对于任何操作前的问题，将第2组（局部利多卡因）和第3组（前列腺周围）的回答分别与第1组（对照组）的回答进行比较，平均疼痛评分无统计学差异。与第1组（对照组）相比，第2组和第3组在总体操作印象方面的操作后疼痛评分显著更低（分别为3.1±1.7和2.6±1.8，而对照组为3.8±1.8；两者P<0.05）。局部组在探头插入方面的操作后评分显著低于对照组（2.2±1.7对3.7±2.1，P<0.05），但前列腺周围组与对照组相比无显著差异（3.0±1.9，P = 0.14）。前列腺周围组在活检操作后的评分显著低于对照组（2.8±1.9对4.3±1.7，P<0.05）。
我们的数据证实，两种局部麻醉技术均能有效减轻患者不适；然而，使用可注射利多卡因进行前列腺周围神经阻滞在减轻操作活检部分的疼痛方面似乎更具针对性。
