Department of Urology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Bangdong-gil 38, Sacheon-myeon, Gangneung, Gangwon-do, Republic of Korea.
Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
World J Urol. 2019 Dec;37(12):2663-2669. doi: 10.1007/s00345-019-02722-w. Epub 2019 Mar 12.
To compare the pain control efficacies of the pelvic plexus block (PPB), periprostatic nerve block (PNB), and controls during a 14-core basal and apical core prostate biopsy.
This randomized controlled study, performed between January 2015 and January 2016, included patients with an abnormal serum prostate-specific antigen (PSA > 3 ng/mL) level or a palpable nodule on digital rectal examination. The enrolled patients were randomized into three groups: Group 1, intrarectal local anesthesia (IRLA, 10 mL of 2% lidocaine jelly) and PPB with 3.0 mL of 2% lidocaine injected at the bilateral pelvic plexus; Group 2, IRLA and PNB with 3.0 mL of 2% lidocaine injected at both periprostatic nerves; and Group 3, only IRLA. Patients answered the visual analog scale (VAS) questionnaire at 6 time points.
This study consisted of 163 patients (Group 1 = 55, Group 2 = 55, and Group 3 = 53). Pain at the apical biopsy location was less in Groups 1 and 2 than in Group 3 (p < 0.001, p < 0.001) and between the two local anesthetic groups (PNB + IRLA vs PPB + IRLA). Group 2 patients reported less pain than Group 1 patients (p = 0.022). Pain during the basal core biopsy was significantly less in Groups 1 and 2 than in Group 3 (p = 0.002, p < 0.001), but there were no significant differences in pain control between the two methods (PNB + IRLA vs PPB + IRLA, p = 0.054) during basal core biopsy.
PNB + IRLA is an effective local anesthetic method for reducing pain when performing apical biopsies compared with PPB + IRLA or IRLA alone.
比较阴部神经丛阻滞（PPB）、前列腺周神经阻滞（PNB）和对照组在 14 针前列腺基底和尖部核心活检中的止痛效果。
这是一项 2015 年 1 月至 2016 年 1 月期间进行的随机对照研究，纳入了血清前列腺特异性抗原（PSA>3ng/mL）水平异常或直肠指检可触及结节的患者。纳入的患者被随机分为三组：第 1 组，直肠内局部麻醉（IRLA，10ml 2%利多卡因凝胶）和双侧阴部神经丛注射 3ml 2%利多卡因的 PPB；第 2 组，IRLA 和前列腺周神经注射 3ml 2%利多卡因的 PNB；第 3 组，仅 IRLA。患者在 6 个时间点回答视觉模拟量表（VAS）问卷。
本研究共纳入 163 例患者（第 1 组 55 例，第 2 组 55 例，第 3 组 53 例）。与第 3 组相比，第 1 组和第 2 组的尖部活检部位疼痛较轻（p<0.001，p<0.001），且两组局部麻醉组间比较（PNB+IRLA 与 PPB+IRLA）也较轻。与第 1 组相比，第 2 组患者的疼痛较轻（p=0.022）。与第 3 组相比，第 1 组和第 2 组的基底核心活检时疼痛较轻（p=0.002，p<0.001），但两种方法（PNB+IRLA 与 PPB+IRLA）在基底核心活检时疼痛控制效果无显著差异（p=0.054）。
与单独使用 PPB+IRLA 或 IRLA 相比，PNB+IRLA 是一种有效的局部麻醉方法，可减轻尖部活检时的疼痛。
