Szlauer Roman, Paras Ljiljana, Fink Klaus G
Department of Urology and Andrology, Paracelsus Medizinische Privatuniversität, Landeskliniken, Salzburg, Austria. szlauer @ inode.at
Urol Int. 2010;84(4):413-7. doi: 10.1159/000296299. Epub 2010 Mar 17.
The aim of this study was to evaluate the efficacy of a combined topical and local anesthesia consisting of a transrectal lidocaine suppository followed by periprostatic nerve block (PNB) in comparison to the combination of transrectally applied lidocaine gel followed by PNB and PNB alone as methods of reducing pain during transrectal prostate biopsy.
100 patients were randomized to four groups and received either a placebo suppository or 10 ml of 2% lidocaine gel or a suppository containing 60 or 120 mg of lidocaine 1 h before biopsy. Additionally, every patient received a PNB using 5 ml 2% lidocaine. After performing an extensive transrectal ultrasound-guided biopsy, pain was evaluated using a visual pain scale.
The mean pain score in the placebo group was 3.4, in the lidocaine gel group it was 3.7, and in the 60 or 120 mg lidocaine suppository groups it was 2.4 and 2.5, respectively. No patient showed vegetative symptoms like sweating or symptomatic hypotonia and no patient had severe pain.
The addition of lidocaine suppositories to PNB as a form of combined anesthesia showed a significantly better pain reduction than the addition of lidocaine gel to PNB or PNB alone.
本研究旨在评估经直肠利多卡因栓剂联合前列腺周围神经阻滞（PNB）的局部与局部联合麻醉，与单独经直肠应用利多卡因凝胶联合PNB以及单独PNB相比，在经直肠前列腺活检过程中减轻疼痛的效果。
100例患者被随机分为四组，在活检前1小时分别接受安慰剂栓剂、10毫升2%利多卡因凝胶或含60毫克或120毫克利多卡因的栓剂。此外，每位患者接受5毫升2%利多卡因的PNB。在进行广泛的经直肠超声引导活检后，使用视觉疼痛量表评估疼痛情况。
安慰剂组的平均疼痛评分为3.4，利多卡因凝胶组为3.7，60毫克或120毫克利多卡因栓剂组分别为2.4和2.5。没有患者出现出汗或症状性低血压等自主神经症状，也没有患者有严重疼痛。
作为联合麻醉形式，在PNB基础上加用利多卡因栓剂比在PNB基础上加用利多卡因凝胶或单独使用PNB能显著更好地减轻疼痛。
