Garcia-Perdomo Herney Andres, Mejia Natalia Guzman, Fernandez Lizeth, Carbonell Jorge
School of Medicine, Department of Urology, Universidad del Valle, Cali, Colombia.
Cent European J Urol. 2019;72(2):121-133. doi: 10.5173/ceju.2019.1874. Epub 2019 Apr 8.
The purpose of this study was to determine the effectiveness and harms of periprostatic block compared with other interventions in patients with clinically suspected prostate cancer who underwent transrectal biopsy to diminish pain.
We included only clinical trials which involved male adults older than 18 years-old suspected of having prostate cancer. The intervention performed was a periprostatic block and the comparators were topical anesthetics, sedatives, placebo/no intervention or combined therapies. The primary outcome was perianal or perineal pain and serious adverse effects (SAE). Literature search was conducted in MEDLINE, EMBASE, LILACS, CENTRAL and non-published literature from inception to March 2019. We performed a network meta-analysis in R.
We included 43 studies in the meta-analysis. Thirteen studies compared periprostatic block vs. placebo/no intervention (the most frequent). Most of the studies had an unclear risk of bias for selection, performance and detection bias and low risk for attrition, reporting and other bias. Periprostatic block (lidocaine) + intrarectal gel (lidocaine + prilocaine) vs. periprostatic block (lidocaine) showed an RR -0.9 (95%CI - 1.9 to 0.074); intrarectal gel (lidocaine) vs. periprostatic block (lidocaine) had a RR 0.77 (95%CI 0.14 to 1.4); placebo/no intervention vs. periprostatic block (lidocaine) + intrarectal gel (lidocaine+prilocaine) RR 3 (95%CI 1.9 to 4); intrarectal gel (lidocaine) versus periprostatic block (lidocaine) + intrarectal gel (lidocaine + prilocaine) RR 1.7 (95%CI 0.64 to 2.7).
The blockage of the periprostatic plexus in the performance of a transrectal ultrasound-guided prostatic biopsy, alone or in combination with intrarectal analgesia or sedation, is an effective method to reduce pain.
本研究的目的是确定在接受经直肠活检以减轻疼痛的临床疑似前列腺癌患者中，前列腺周围阻滞与其他干预措施相比的有效性和危害。
我们仅纳入了涉及年龄超过18岁疑似患有前列腺癌的男性成年人的临床试验。所实施的干预措施为前列腺周围阻滞，对照措施为局部麻醉剂、镇静剂、安慰剂/无干预或联合治疗。主要结局为肛周或会阴疼痛以及严重不良反应（SAE）。从创刊至2019年3月，在MEDLINE、EMBASE、LILACS、CENTRAL以及未发表的文献中进行了文献检索。我们在R软件中进行了网状Meta分析。
我们在Meta分析中纳入了43项研究。13项研究比较了前列腺周围阻滞与安慰剂/无干预（最常见）。大多数研究在选择、实施和检测偏倚方面的偏倚风险不明确，在失访、报告和其他偏倚方面的风险较低。前列腺周围阻滞（利多卡因）+直肠内凝胶（利多卡因+丙胺卡因）与前列腺周围阻滞（利多卡因）相比，RR为-0.9（95%CI为-1.9至0.074）；直肠内凝胶（利多卡因）与前列腺周围阻滞（利多卡因）相比，RR为0.77（95%CI为0.14至1.4）；安慰剂/无干预与前列腺周围阻滞（利多卡因）+直肠内凝胶（利多卡因+丙胺卡因）相比，RR为3（95%CI为1.9至4）；直肠内凝胶（利多卡因）与前列腺周围阻滞（利多卡因）+直肠内凝胶（利多卡因+丙胺卡因）相比，RR为1.7（95%CI为0.64至2.7）。
在经直肠超声引导下进行前列腺活检时，单独或联合直肠内镇痛或镇静对前列腺周围神经丛进行阻滞，是减轻疼痛的有效方法。
