Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy.
BJU Int. 2012 Jun;109(12):1776-80. doi: 10.1111/j.1464-410X.2011.10622.x. Epub 2011 Oct 14.
What's known on the subject? and What does the study add? Study Type - Harm Reduction RCT Level of Evidence 1b The combination of perianal-intrarectal lidocaine-prilocaine cream and periprostatic nerve block effectively counteracts probe and sampling related pain during transrectal prostate biopsy, but not pain due to periprostatic infiltration. The novel combination of lidocaine-prilocaine cream and lidocaine-ketorolac gel, both administered perianal-intrarectally, provides the same probe and sampling-related pain relief than combined perianal-intrarectal lidocaine-prilocaine cream and periprostatic nerve block and prevents the non-negligible pain due to periprostatic infiltration, thus leading to better overall patients' compliance to the procedure.
• To compare the efficacy and safety of combined perianal-intrarectal (PI) lidocaine-prilocaine (LP) cream and lidocaine-ketorolac (LK) gel with combined PI LP cream and periprostatic nerve block (PPNB) in relieving pain during transrectal ultrasonography guided prostate biopsy (TPB).
• In all, 200 patients were randomized to receive combined PI LP cream and LK gel (group 1) or combined PI LP cream and PPNB (group 2) before TPB. • The 0-10-point visual analogue scale (VAS) was used for assessing pain at probe insertion and movements (VAS-1), periprostatic infiltration (VAS-2) when applied, and prostate sampling (VAS-3), as well as maximal procedural pain (MPP). • Complications occurring ≤ 20 days after the TPB were recorded.
• The groups were comparable for patients' age, serum PSA level, prostate volume, and cancer detection rate. • All patients tolerated the procedure well. The two anaesthetic regimens provided almost equal mean VAS-1 (0.33 vs 0.37; P= 0.701) and VAS-3 (0.52 vs 0.51; P= 0.954) scores, but patients in group 2 reported significantly greater MPP scores (0.68 vs 1.53; P < 0.001) as periprostatic infiltration was the most painful part of the procedure (mean VAS-2: 1.33). • Complications rate was similar in the two groups (1% vs 2%; P= 0.38).
• The novel combination of PI LP cream and LK gel provided the same probe- and sampling- related pain relief as combined PI LP and PPNB; moreover, by preventing the non-negligible periprostatic infiltration pain, it provided significantly better overall patients' compliance to the procedure. • Being safe and easy to administer, this novel non-infiltrative regimen has the potential to replace infiltrative anaesthesia in relieving pain during TPB.
比较经直肠超声引导前列腺活检（TPB）前联合应用肛周-直肠内（PI）利多卡因-丙胺卡因（LP）乳膏和利多卡因-酮咯酸（LK）凝胶（组 1）与联合应用 PI LP 乳膏和前列腺周围神经阻滞（PPNB）（组 2）缓解 TPB 过程中疼痛的疗效和安全性。
共 200 例患者随机分为两组，分别接受联合 PI LP 乳膏和 LK 凝胶（组 1）或联合 PI LP 乳膏和 PPNB（组 2）治疗。采用 0-10 分视觉模拟评分（VAS）评估探针插入和移动时的疼痛（VAS-1）、应用时前列腺周围浸润（VAS-2）和前列腺取样（VAS-3）以及最大程序疼痛（MPP）。记录 TPB 后≤20 天内发生的并发症。
两组患者的年龄、血清 PSA 水平、前列腺体积和癌症检出率均无差异。所有患者均能很好地耐受该过程。两种麻醉方案提供了几乎相同的平均 VAS-1（0.33 与 0.37；P=0.701）和 VAS-3（0.52 与 0.51；P=0.954）评分，但组 2 患者报告的 MPP 评分显著更高（0.68 与 1.53；P<0.001），因为前列腺周围浸润是该过程最疼痛的部分（平均 VAS-2：1.33）。两组并发症发生率相似（1%与 2%；P=0.38）。
PI LP 乳膏和 LK 凝胶的新组合提供了与联合应用 PI LP 和 PPNB 相同的探针和取样相关的疼痛缓解；此外，通过预防不可忽视的前列腺周围浸润疼痛，它显著提高了患者对该过程的整体依从性。这种安全且易于管理的新非浸润性方案有可能替代浸润性麻醉，以缓解 TPB 过程中的疼痛。
