Tiong H Y, Liew L C H, Samuel M, Consigliere D, Esuvaranathan K
Department of Urology, National University Hospital, Singapore, Singapore.
Prostate Cancer Prostatic Dis. 2007;10(2):127-36. doi: 10.1038/sj.pcan.4500935. Epub 2007 Jan 9.
This meta-analysis evaluated the efficacy and safety of periprostatic nerve block (PPNB) and intrarectal local anesthestic (IRLA) gel in alleviating pain during prostate biopsy. Electronic databases MEDLINE, Cochrane Central Register of Controlled Trials and EMBASE were searched to identify all randomized controlled trials comparing PPNB with periprostatic placebo injection, no injection or with IRLA. Studies for inclusion were identified and extracted by two authors independently. The main outcome measure was patients' assessment of mean pain scores on a 10-point scale at the end of the biopsy procedure. Secondary outcomes were complications and adverse events. Continuous data from the trials were combined by calculating the weighted mean difference (WMD) with its 95% confidence interval. In total, 25 studies met the inclusion criteria. Twenty studies involving 1685 patients compared PPNB with either no anesthesia or with placebo injection controls, showing a significant reduction in pain score in the anesthetic group (WMD -2.09, 95% CI -2.44 to -1.75, P<0.00001). Five studies with 466 patients compared IRLA and control. Although IRLA was associated with pain reduction, the effect size was not statistically significant (WMD -0.22, 95% CI -0.56 to 0.12). Six studies with 872 patients compared PPNB with IRLA, showing a significant pain reduction in the former group (WMD -1.53, 95% CI -2.67 to -0.39, P=0.008). No trials reported an increase in complications in the treatment arms. In conclusion, the evidence from randomized controlled trials shows that local anesthetic given as a PPNB, but not as an intrarectal instillation, is effective and safe in alleviating pain from transrectal ultrasound biopsy of the prostate.
本荟萃分析评估了前列腺周围神经阻滞（PPNB）和直肠内局部麻醉（IRLA）凝胶在减轻前列腺活检过程中疼痛方面的疗效和安全性。检索了电子数据库MEDLINE、Cochrane对照试验中央注册库和EMBASE，以确定所有比较PPNB与前列腺周围安慰剂注射、不注射或与IRLA的随机对照试验。纳入研究由两位作者独立识别和提取。主要结局指标是患者在活检程序结束时对10分制平均疼痛评分的评估。次要结局是并发症和不良事件。通过计算加权平均差（WMD）及其95%置信区间来合并试验中的连续数据。共有25项研究符合纳入标准。20项涉及1685例患者的研究比较了PPNB与无麻醉或安慰剂注射对照，结果显示麻醉组疼痛评分显著降低（WMD -2.09，95%CI -2.44至-1.75，P<0.00001）。5项涉及466例患者的研究比较了IRLA和对照。虽然IRLA与疼痛减轻有关，但效应大小无统计学意义（WMD -0.22，95%CI -0.56至0.12）。6项涉及872例患者的研究比较了PPNB与IRLA，结果显示前一组疼痛显著减轻（WMD -1.53，95%CI -2.67至-0.39，P=0.008）。没有试验报告治疗组并发症增加。总之，随机对照试验的证据表明，以PPNB而非直肠内滴注方式给予局部麻醉剂在减轻经直肠超声引导下前列腺活检疼痛方面是有效且安全的。
