Alabi Taiwo Opeyemi, Tijani Kehinde Habeeb, Adeyomoye Adekunle Ayokunle, Jeje Emmanuel Ajibola, Anunobi Charles Chidozie, Ogunjimi Moses Adebisi, Ojewola Rufus Wale, Akanmu Olanrewaju Nurudeen, Oliyide Abisola Ekundayo, Orakwe Dubem Ejikeme
Department of Surgery, Urology Unit, Lagos University Teaching Hospital/College of Medicine, University of Lagos, Lagos, Nigeria.
Department of Radiology, Lagos University Teaching Hospital/College of Medicine, University of Lagos, Lagos, Nigeria.
Niger Postgrad Med J. 2018 Oct-Dec;25(4):252-256. doi: 10.4103/npmj.npmj_145_18.
Periprostatic nerve block (PNB) which appears to be the gold standard for pain relief during transrectal ultrasound-guided prostate (TrusP) biopsy has been proven to be lacking in providing satisfactory anaesthesia during transrectal ultrasound (Trus) probe insertion into the anorectum necessitating the addition of another technique to produce a 'balanced' anaesthesia. The aim of this study was to determine whether combined intrarectal lidocaine gel and periprostatic nerve block (cGPNB) will provide adequate anaesthesia at all stages of TrusP compared with caudal block (CB).
Data were prospectively collected from patients with indications for TrusP who were randomly assigned to either cGPNB (Group A) or CB (Group B). Comparative analysis of the numerical rating pain score (NRS) between two groups was done after administration of anaesthesia, Trus probe insertion, biopsy needle puncture of the prostate and 1 h after biopsy.
There were 56 patients in Group A and 53 in Group B. There was no significant difference in NRS grouping between the two arms of the study after administration of anaesthesia (P = 0.93), biopsy needle puncture of the prostate (P = 0.28) and 1 h after the procedure (P = 0.39). There was no statistically significant difference in the number of patients with no/mild pain between the two arms of the study during probe insertion (P = 0.65). None of the patients in both arms of the study had severe pain. Across Group A and B, 35 (62.5%) versus 40 (75.5%), 20 (35.7%) versus 11 (20.8%) and 1 (1.8%) versus 2 (3.8%) adjudged the procedure as very tolerable, fairly tolerable and intolerable respectively (P = 0.20). All the patients in Group A versus 49 (92.5%) in Group B will choose the same anaesthesia for subsequent biopsies (P = 0.11).
cGPNB provides balanced anaesthesia at all stages of TrusP with excellent patient tolerability.
前列腺周围神经阻滞（PNB）似乎是经直肠超声引导下前列腺穿刺活检（TrusP）时缓解疼痛的金标准，但已被证明在将经直肠超声（Trus）探头插入肛门直肠时无法提供令人满意的麻醉效果，因此需要增加另一种技术以产生“平衡”麻醉。本研究的目的是确定与骶管阻滞（CB）相比，直肠内利多卡因凝胶联合前列腺周围神经阻滞（cGPNB）在TrusP的所有阶段是否能提供充分的麻醉。
前瞻性收集有TrusP适应证的患者的数据，这些患者被随机分配至cGPNB组（A组）或CB组（B组）。在麻醉给药后、Trus探头插入、前列腺活检针穿刺以及活检后1小时，对两组的数字疼痛评分（NRS）进行比较分析。
A组有56例患者，B组有53例患者。在麻醉给药后（P = 0.93）、前列腺活检针穿刺时（P = 0.28）以及术后1小时（P = 0.39），研究的两组之间NRS分组无显著差异。在探头插入期间，研究的两组之间无/轻度疼痛患者的数量无统计学显著差异（P = 0.65）。研究两组中的患者均无严重疼痛。在A组和B组中，分别有35例（62.5%）对40例（75.5%）、20例（35.7%）对11例（20.8%）以及1例（1.8%）对2例（3.8%）认为该操作非常可耐受、尚可耐受和无法耐受（P = 0.20）。A组的所有患者与B组的49例（92.5%）患者会选择相同的麻醉用于后续活检（P = 0.11）。
cGPNB在TrusP的所有阶段均能提供平衡麻醉，患者耐受性良好。
