Jindal T, Mandal S N, Biswas G, Karmakar D
Department of Urology, Calcutta National Medical College, 32 Gorachand Road, Beniapukur, Kolkata - 700 014, India.
Ann R Coll Surg Engl. 2013 Jul;95(5):361-4. doi: 10.1308/003588413X13629960046318.
The choice of analgesia during prostate biopsy remains controversial. The pain has dual origin: from the insertion of the probe as well as the biopsy itself. Periprostatic nerve block (PPNB) is currently the gold standard modality for decreasing pain of prostate biopsy but it does not alleviate the pain of probe insertion. A randomised controlled trial was performed to test the efficacy and safety of the combination of topical application of diltiazem gel and PPNB for pain control during transrectal ultrasonography guided prostate biopsy.
A total of 73 patients who were to undergo their first prostate biopsy were randomised to receive either 2ml of 2% topical diltiazem gel or a placebo 15 minutes before the biopsy. All the patients then had a PPNB using 1% lignocaine. A ten- point visual analogue scale was used to record the pain immediately after the insertion of the probe and during the biopsy. Any adverse effects were also recorded.
There was no significant difference in the mean age and prostate volumes between the groups. There was a significantly lower mean pain score due to probe insertion in those patients who received topical diltiazem than in the placebo group (p<0.0001). There was no significant difference between the pain scores during the biopsy itself between the two groups.
Topical diltiazem significantly reduces the pain of probe insertion during prostate biopsy and can be used effectively as an adjuvant to PPNB.
前列腺活检期间的镇痛选择仍存在争议。疼痛有双重来源：来自探头插入以及活检本身。前列腺周围神经阻滞（PPNB）目前是减轻前列腺活检疼痛的金标准方法，但它不能减轻探头插入时的疼痛。进行了一项随机对照试验，以测试在经直肠超声引导下前列腺活检期间，地尔硫卓凝胶局部应用与PPNB联合用于疼痛控制的有效性和安全性。
共有73例即将接受首次前列腺活检的患者被随机分组，在活检前15分钟接受2ml 2%的地尔硫卓局部凝胶或安慰剂。然后所有患者均使用1%利多卡因进行PPNB。使用十点视觉模拟量表记录探头插入后及活检期间的疼痛。还记录了任何不良反应。
两组之间的平均年龄和前列腺体积无显著差异。接受局部应用地尔硫卓的患者因探头插入导致的平均疼痛评分显著低于安慰剂组（p<0.0001）。两组在活检期间的疼痛评分之间无显著差异。
局部应用地尔硫卓可显著减轻前列腺活检期间探头插入的疼痛，并可有效用作PPNB的辅助手段。
