Urology Clinic, University of Sarajevo Clinics Centre, Bolnicka 25, 71000 Sarajevo, Bosnia and Herzegovina.
Bosn J Basic Med Sci. 2010 Feb;10(1):68-72. doi: 10.17305/bjbms.2010.2740.
We have evaluated objectively pain tolerance in transrectal ultrasound-guided prostate biopsy (TRUS) using local periprostatic per rectal anesthesia as compared to the conventional method. From November 2008 to May 2009, 90 patients underwent transrectal ultrasound-guided prostate biopsy at Department of Urology, Clinical Center University Sarajevo. 90 patients who fulfilled the inclusion criteria were randomized into 3 groups of 30 patients each. Group 1 received periprostatic local anesthesia with 2% lidocaine, group 2 received Voltaren supp placed in rectum an hour before biopsy while group 3 received no local anesthesia. Pain scale responses were analyzed for each aspect of the biopsy procedure with a visual analog scale of 0-none to 10-maximal. There was no difference between the 3 groups in pain scores during digital rectal examination, intrarectal injection and probe insertion. The mean pain scores during needle insertion in group 1 receiving periprostatic nerve block and in group 2 receiving Voltaren supp were 3,10 +/- 2,32 and 5,15 +/- 2,01 respectively. In group 3 (no local anesthesia), mean pain scores were 6,06 +/- 2,95 which was found to be significantly different (p < 0,001). However, morbidity after the biopsy was not statistically different between all 3 groups. TRUS-guided prostate biopsy is a traumatic and painful experience, but the periprostatic blockage use is clearly associated with more tolerance and patient comfort during the exam. It is an easy, safe, acceptable and reproducible technique and should be considered for all patients undergoing TRUS biopsy regardless of age or number of biopsies.
我们通过经直肠超声引导前列腺活检（TRUS）中使用局部前列腺周围直肠内麻醉与传统方法进行了客观的疼痛耐受评估。2008 年 11 月至 2009 年 5 月，90 例患者在萨拉热窝临床中心大学泌尿科接受了经直肠超声引导前列腺活检。90 例符合纳入标准的患者被随机分为 3 组，每组 30 例。第 1 组接受 2%利多卡因局部前列腺周围麻醉，第 2 组在活检前 1 小时将 Voltaren 栓剂放入直肠，第 3 组不接受局部麻醉。使用视觉模拟量表（0-无至 10-最大）分析活检过程各个方面的疼痛评分。3 组在直肠指检、直肠内注射和探头插入过程中的疼痛评分无差异。在接受前列腺周围神经阻滞的第 1 组和接受 Voltaren 栓剂的第 2 组中，在针插入期间的平均疼痛评分为 3.10+/-2.32 和 5.15+/-2.01。在第 3 组（无局部麻醉）中，平均疼痛评分为 6.06+/-2.95，差异有统计学意义（p<0.001）。然而，活检后的发病率在所有 3 组之间无统计学差异。TRUS 引导下前列腺活检是一种创伤性和痛苦的体验，但前列腺周围阻滞的使用显然与检查过程中的更高的耐受性和患者舒适度相关。它是一种简单、安全、可接受和可重复的技术，应考虑用于所有接受 TRUS 活检的患者，无论年龄或活检次数如何。
