Anup K, Pawan V, Niraj K, Biswajit N, Nayan M K
Department of Urology, V.M. Medical College and Safdarjang Hospital, New Delhi, India.
Minerva Urol Nefrol. 2013 Mar;65(1):77-82.
The aim of this paper was to optimize pain control during transrectal ultrasound (TRUS) guided prostate biopsy, the efficacy and safety of three different analgesic techniques were compared.
Two hundred and forty patients were prospectively randomized into 3 groups before TRUS guided prostate biopsy. Group A received combined periprostatic nerve block (PPNB) and perianal-intrarectal lidocaine-prilocaine (PILP) cream; group B: PILP cream; group C: PPNB. Pain was evaluated using 10-point Visual Analog Scale (VAS).
VAS during TRUS was lower in groups A and B vs. C (mean 1.3,1.4 vs. 5.1, P<0.001); VAS for PPNB was lower in group A and group B vs. C (mean 1.1,1.3 vs. 3.5, P<0.001). VAS for sampling wase lower in group A as compared to B and C (mean 0.6, 3.5 and 1.4, P<0.001). VAS on stratified analysis was significantly lower in groupA vs. B and C in patients <60 years, prostate >50 cc and those with lower anorectal compliance (P<0.001). The overall complication rate was similar in all three groups.
The combination of PILP and PPNB provides better analgesia, especially in patients <60 years, prostate volume >50 cc and lower anorectal compliance as compared to two modalities used alone during the sampling part of TRUS guided prostate biopsy with no increase in the complication rate.
本文旨在优化经直肠超声（TRUS）引导下前列腺穿刺活检术中的疼痛控制，比较三种不同镇痛技术的疗效和安全性。
240例患者在TRUS引导下前列腺穿刺活检术前被前瞻性随机分为3组。A组接受前列腺周围神经阻滞（PPNB）联合肛周-直肠内利多卡因-丙胺卡因（PILP）乳膏；B组：PILP乳膏；C组：PPNB。采用10分视觉模拟评分法（VAS）评估疼痛程度。
TRUS检查期间，A组和B组的VAS评分低于C组（平均1.3、1.4 vs. 5.1，P<0.001）；PPNB操作时，A组和B组的VAS评分低于C组（平均1.1、1.3 vs. 3.5，P<0.001）。A组采样时的VAS评分低于B组和C组（平均0.6、3.5和1.4，P<0.001）。分层分析显示，在年龄<60岁、前列腺体积>50 cc以及直肠肛门顺应性较低的患者中，A组的VAS评分显著低于B组和C组（P<0.001）。三组的总体并发症发生率相似。
在TRUS引导下前列腺穿刺活检的采样过程中，与单独使用两种方法相比，PILP与PPNB联合使用可提供更好的镇痛效果，尤其是在年龄<60岁、前列腺体积>50 cc以及直肠肛门顺应性较低的患者中，且不增加并发症发生率。
