Horinaga Minoru, Nakashima Jun, Nakanoma Takashi
Department of Urology, National Health Insurance Minamitama Hospital, Tokyo, Japan.
Urology. 2006 Aug;68(2):348-51. doi: 10.1016/j.urology.2006.02.025.
To investigate the clinical efficacy of a caudal block compared with periprostatic local anesthesia for transrectal ultrasound-guided multicore prostate needle biopsy.
A total of 100 patients who had undergone initial prostate biopsy using a systematic five-region biopsy by a single operator were investigated. The patients were randomly divided into two groups, with each group receiving a different anesthetic modality before biopsy. Group 1 received periprostatic local anesthesia and group 2 received a caudal block. Both groups received 10 mL 1% lidocaine before biopsy. A 10-point visual analog scale was used to assess patient pain and anxiety. The duration between anesthesia induction and the beginning of the biopsy was measured.
Patients who received local anesthesia (group 1) reported significantly less pain immediately after biopsy, with an average score of 1.1 compared with 2.1 in group 2 (caudal block, P = 0.01). Both groups were comparable regarding age, prostate-specific antigen level, digital rectal examination findings, prostate size, number of biopsy cores, level of prebiopsy anxiety, body mass index, and histologic findings. Group 1 required a significantly shorter period of anesthesia (198.5 seconds) than did group 2 (594.5 seconds, P <0.0001). No anesthetic-related side effects occurred in either group.
The results of our study have shown that the caudal block provides less effective anesthesia than periprostatic local anesthesia with the same dose of lidocaine for prostate biopsy. We have concluded that local anesthesia is a safe, simple, and rapid method of pain relief during prostate biopsy.
探讨与前列腺周围局部麻醉相比，骶管阻滞用于经直肠超声引导下多芯前列腺穿刺活检的临床疗效。
对100例由同一操作者采用系统五区活检法进行初次前列腺穿刺活检的患者进行研究。患者被随机分为两组，每组在活检前接受不同的麻醉方式。第1组接受前列腺周围局部麻醉，第2组接受骶管阻滞。两组在活检前均接受10 mL 1%利多卡因。采用10分视觉模拟量表评估患者的疼痛和焦虑程度。测量麻醉诱导至活检开始之间的时间。
接受局部麻醉的患者（第1组）在活检后立即报告的疼痛明显较轻，平均评分为1.1分，而第2组（骶管阻滞）为2.1分（P = 0.01）。两组在年龄、前列腺特异性抗原水平、直肠指检结果、前列腺大小、穿刺芯数量、活检前焦虑程度、体重指数和组织学结果方面具有可比性。第1组所需的麻醉时间（198.5秒）明显短于第2组（594.5秒，P <0.0001）。两组均未发生与麻醉相关的副作用。
我们的研究结果表明，在相同剂量利多卡因用于前列腺活检时，骶管阻滞提供的麻醉效果不如前列腺周围局部麻醉。我们得出结论，局部麻醉是前列腺活检期间一种安全、简单且快速的减轻疼痛的方法。
