Aus Gunnar, Damber Jan-Erik, Hugosson Jonas
Department of Urology, Sahlgrens University Hospital, Göteborg, Sweden.
Scand J Urol Nephrol. 2005;39(2):124-9. doi: 10.1080/00365590510007784.
To evaluate the efficacy of different methods for decreasing pain and discomfort in men undergoing transrectal ultrasound-guided prostate biopsies and to propose a clinical standard useful for pain relief.
A MEDLINE search using the search terms "anaesthesia" and "prostate biopsy" was performed in November 2004. The search yielded 198 papers, 45 of which were found to relate to the subject and were in the English language.
Intravenously administered sedoanalgesia seems to be effective but is cumbersome to handle in everyday practice. In one study, i.v. tramadol has been shown to be effective, and the same goes for diclofenac 100 mg given as a suppository 1 h prior to the biopsy. Inhaled nitrous oxide (Entonox) works well but is not widely available. A rectally administered gel containing local anaesthetic seems to have very limited efficacy. Periprostatic injection of a local anaesthetic was used in most studies, nearly all of which showed that it was effective in comparison with placebo or rectal gel. A minimum of 10 cm3 seems to be necessary for optimal effect.
At the present time, perirectal injection of a local anaesthetic is the preferred method of pain relief in conjunction with transrectal prostate biopsies.
评估不同方法减轻经直肠超声引导下前列腺穿刺活检男性患者疼痛和不适的效果，并提出有助于缓解疼痛的临床标准。
2004年11月利用检索词“麻醉”和“前列腺活检”在医学期刊数据库（MEDLINE）进行检索。检索得到198篇论文，其中45篇被发现与该主题相关且为英文文献。
静脉注射镇静镇痛剂似乎有效，但在日常实践中操作不便。一项研究表明静脉注射曲马多有效，活检前1小时给予100毫克双氯芬酸栓剂也有同样效果。吸入氧化亚氮（恩多诺克斯）效果良好，但使用并不广泛。含局部麻醉剂的直肠凝胶疗效似乎非常有限。大多数研究使用前列腺周围注射局部麻醉剂，几乎所有研究都表明与安慰剂或直肠凝胶相比它是有效的。最佳效果似乎至少需要10立方厘米。
目前，直肠周围注射局部麻醉剂是经直肠前列腺活检时缓解疼痛的首选方法。
