Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China.
Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China.
Sci Rep. 2017 Jan 12;7:40421. doi: 10.1038/srep40421.
A meta-analysis was performed to evaluate the efficacy of local anesthesia in alleviating pain during prostate biopsy. We searched relevant articles in PubMed and Embase. The included studies should be randomized controlled trials (RCT) using local anesthesia to alleviate pain during biopsy, which was recorded by a pain scale. Analgesic efficacy of different local anesthesia techniques were analyzed, including intrarectal local anesthesia (IRLA), periprostatic nerve block (PNB), pelvic plexus block (PPB) and intraprostatic local anesthesia (IPLA). We included 46 RCTs. PNB significantly reduced pain score compared with placebo (-1.27 [95% confidence interval [95% CI] -1.72, -0.82]) or no injection (-1.01 [95% CI -1.2, -0.82]). IRLA with prilocaine-lidocaine cream could also reduced pain (-0.45 [95% CI -0.76, -0.15]), while the IRLA with lidocaine gel was not effective (-0.1 [95% CI -0.24, 0.04]). PNB lateral to the neurovascular bundle had better analgesic effect than at prostate apex (P = 0.02). Combination use of PPB and IRLA considerably alleviated pain of patients compared with the combination of PNB and IRLA (-1.32 [95% CI -1.59, -1.06]). In conclusion, local anesthesia could alleviate patients' pain during the prostate biopsy. PNB was not so effective as PPB.
一项荟萃分析评估了局部麻醉在缓解前列腺活检疼痛中的疗效。我们在 PubMed 和 Embase 中搜索了相关文章。纳入的研究应为使用局部麻醉减轻活检疼痛的随机对照试验（RCT），疼痛程度由疼痛量表记录。分析了不同局部麻醉技术的镇痛效果，包括直肠内局部麻醉（IRLA）、前列腺周围神经阻滞（PNB）、骨盆丛阻滞（PPB）和前列腺内局部麻醉（IPLA）。我们纳入了 46 项 RCT。与安慰剂（-1.27 [95%置信区间 [95%CI] -1.72，-0.82]）或不注射（-1.01 [95%CI -1.2，-0.82]）相比，PNB 显著降低了疼痛评分。用普鲁卡因-利多卡因乳膏进行 IRLA 也能减轻疼痛（-0.45 [95%CI -0.76，-0.15]），而利多卡因凝胶的 IRLA 则无效（-0.1 [95%CI -0.24，0.04]）。神经血管束旁的 PNB 比前列腺尖部的 PNB 具有更好的镇痛效果（P = 0.02）。与 PNB 和 IRLA 联合使用相比，PPB 和 IRLA 的联合使用可显著减轻患者的疼痛（-1.32 [95%CI -1.59，-1.06]）。总之，局部麻醉可缓解前列腺活检患者的疼痛。PNB 不如 PPB 有效。
