Advantages of caudal block over intrarectal local anesthesia plus periprostatic nerve block for transrectal ultrasound guided prostate biopsy

Na Wang, Yaowen Fu, Haichun Ma, Jinguo Wang, Yang Gao, Na Wang, Yaowen Fu, Haichun Ma, Jinguo Wang, Yang Gao

Abstract

Objective: To compare caudal block with intrarectal local anesthesia plus periprostatic nerve block for transrectal ultrasound guided prostate biopsy.

Methods: One hundred and ninety patients scheduled for transrectal ultrasound guided prostate biopsy were randomized equally into Group-A who received caudal block (20 ml 1.2% lidocaine) and Group-B who received intrarectal local anesthesia (0.3% oxybuprocaine cream) plus periprostatic nerve block (10 ml 1% lidocaine plus 0.5% ropivacaine) before biopsy. During and after the procedure, the patients rated the level of pain/discomfort at various time points. Complications during the whole study period and the patient overall satisfaction were also evaluated.

Results: More pain and discomfort was detected during periprostatic nerve block than during caudal block. Pain and discomfort was significantly lower during prostate biopsy and during the manipulation of the probe in the rectum in Group-A than in Group-B. No significant differences were detected in the pain intensity after biopsy and side effects between the two groups.

Conclusions: Caudal block provides better anesthesia than periprostatic nerve block plus intrarectal local anesthesia for TRUS guided prostate biopsy without an increase of side effects.

Keywords: Biopsy; Caudal block; Periprostatic nerve block; Prostate; Transrectal; Ultrasound.

Conflict of interest statement

Declaration of interest: The authors have no financial conflicts of interest

Figures

Fig.1
Fig.1
Box plots of VAS scores at various time points. Results are expressed in median. The top and bottom of each box indicate 75th and 25th percentiles and the error bars minimum and maximum values. Abbreviations: VAS, visual analogue scale; T1, during caudal block or periprostatic nerve block; T2, during introduction and presence of the probe in the rectum; T3, during biopsy procedure; T4, 30 minutes after the procedure and T5, a day after the procedure; Group-A, the caudal block group; Group-B, The intrarectal local anesthesia and periprostatic nerve block group. * indicates P<0.05, *** indicates P<0.001.

References

    1. Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T, et al. EAU guidelines on prostate cancer part 1: Screening, diagnosis, and local treatment with curative intent-update 2013. Eur Urol. 2014;65:124–137. doi:10.1016/j.eururo.2013.09.046.
    1. Maccagnano C, Scattoni V, Roscigno M, Raber M, Angiolilli D, Montorsi F, et al. Anaesthesia in transrectal prostate biopsy: Which is the most effective technique? Urol Int. 2011;87:1–13. doi:10.1159/000327827. Epub 2011 16.
    1. Raber M, Scattoni V, Roscigno M, Dehò F, Briganti A, Salonia A, et al. Topical prilocaine-lidocaine cream combined with peripheral nerve block improves pain control in prostatic biopsy: results from a prospective randomized trial. Eur Urol. 2008;53:967–973.
    1. Giannarini G, Autorino R, Valent F, Mogorovich A, Manassero F, De Maria M, et al. Combination of perianal-intrarectal lidocaine-prilocaine cream & periprostatic nerve block for pain control during transrectal ultrasound guided prostate biopsy: A randomized, controlled trial. J Urol. 2009;181:585–591. doi:10.1016/j.juro.2008.10.002.
    1. Cantiello F, Imperatore V, Iannuzzo M, Scibelli G, Di Meo S, Fusco F, et al. Periprostatic nerve block (PNB) alone vs PNB combined with an anaesthetic-myorelaxant agent cream for prostate biopsy: A prospective, randomized double-arm study. BJU Int. 2009;103:1195–1198. doi:10.1111/j.1464-410X.2008.08198.x.
    1. Crundwell MC, Cooke PW, Wallace DM. Patients’ tolerance of transrectal ultrasound-guided prostatic biopsy: An audit of 104 cases. BJU Int. 1999;83:792–795.
    1. Irani J, Fournier F, Bon D, Gremmo E, Doré B, Aubert J. Patient tolerance of transrectal ultrasound-guided biopsy of the prostate. Br J Urol. 1997;79:608–610.
    1. Luscombe CJ, Cooke PW. Pain during prostate biopsy. Lancet. 2004;363:1840–1841.
    1. Adebamowo CA. Caudal anesthesia in the clinical assessment of painful anal lesions. Afr J Med Sci. 2000;29:133–134.
    1. Ikuerowo SO, Popoola AA, Olapade-Olaopa EO, Okeke LI, Shittu OB, Adebayo SA, et al. Caudal block anesthesia for transrectal prostate biopsy. Int Urol Nephrol. 2010;42:19–22.
    1. Cesur M, Yapanoglu T, Erdem AF, Ozbey I, Alici HA, Aksoy Y. Caudal analgesia for prostate biopsy. Acta Anesthesiol Scand. 2010;54:557–561. doi:10.1111/j.1399-6576.2009.02168.x.
    1. Horinaga M, Najashima J, Nakanoma T. Efficacy compared between caudal block & periprostatic local anesthesia for transrectal ultrasound-guided prostate needle biopsy. Urology. 2006;68:348–351.
    1. Jo DH. Ultrasound Guided Technique for the Caudal Epidural Injection. Korean J Pain. 2015;28:290–291. doi:10.3344/kjp.2015.28.4.290.
    1. Yun TJ, Lee HJ, Kim SH, Lee SE, Cho JY, Seong CK, et al. Does the intrarectal instillation of lidocaine gel before periprostatic neurovascular bundle block during transrectal ultrasound guided prostate biopsies improve analgesic efficacy? A prospective, randomized trial. J Urol. 2007;178:103–106.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel