Local anesthesia for pain control during transrectal ultrasound-guided prostate biopsy: a systematic review and meta-analysis

Pu Yan, Xiao-Yan Wang, Wei Huang, Yong Zhang, Pu Yan, Xiao-Yan Wang, Wei Huang, Yong Zhang

Abstract

Background: A meta-analysis was performed to evaluate the efficacy and safety of intrarectal local anesthestic (IRLA), periprostatic nerve block (PPNB), and the combined modalities in alleviating the pain during transrectal ultrasound (TRUS)-guided prostate biopsy.

Materials and methods: A literature review was performed to identify all published randomized controlled trials (RCTs) about IRLA vs no anesthesia or placebo gel; PPNB vs no injection, periprostatic placebo injection, or IRLA; combined PPNB and IRLA vs PPNB alone; and combined PPNB and intraprostatic nerve block (IPNB) vs PPNB alone before TRUS-guided biopsy. Sources included MEDILINE, EMBASE, and Cochrane Library from 1980 to 2016. The main outcomes were biopsy pain score, probe manipulation pain score, and anesthetic infiltration pain score assessed by the visual pain scale.

Results: A total of 26 articles involving 36 RCTs were used in this analysis: Although IRLA can lead to pain reduction, the result was not statistically significant when compared with no anesthesia or placebo gel (weighted mean difference [WMD]: -0.22, 95% CI: -0.45 to 0, P=0.06). PPNB can lead to significantly lower biopsy pain scores when compared with no analgesia (WMD: -1.32, 95% CI: -1.68 to -0.95, P<0.00001), placebo injection (WMD: -2.62, 95% CI: -3.16 to -2.07, P<0.00001), or IRLA (WMD: -1.31, 95% CI: -1.40 to -1.22, P<0.00001). PPNB + IRLA can lead to significantly lower biopsy pain scores when compared with PPNB alone (WMD: -0.45, 95% CI: -0.62 to -0.28, P<0.00001). PPNB + IPNB can lead to significantly lower biopsy pain scores when compared with PPNB alone (WMD: -0.73, 95% CI: -0.92 to -0.55, P<0.00001). There were no severe reported general or local complications related to local anesthesia.

Conclusion: This meta-analysis indicates that a combination of PPNB and IRLA/IPNB is effective and safe in alleviating the pain during TRUS-guided prostate biopsy. Further high-quality RCTs are needed to validate this result.

Keywords: biopsy; local anesthesia; meta-analysis; pain control; prostate.

Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
A flow diagram of the study selection process.
Figure 2
Figure 2
Forest plot comparing IRLA with control. Abbreviation: CI, confidence interval; IRLA, intrarectal local anesthestic; SD, standard deviation; IV, means inverse variance.
Figure 3
Figure 3
Forest plot comparing PPNB with different controls. Abbreviation: CI, confidence interval; PPNB, periprostatic nerve block; SD, standard deviation.
Figure 4
Figure 4
Forest plot comparing PPNB with IRLA. Abbreviations: CI, confidence interval; IRLA, intrarectal local anesthestic; PPNB, periprostatic nerve block; SD, standard deviation.
Figure 5
Figure 5
Forest plot comparing PPNB + IRLA with PPNB. Abbreviations: CI, confidence interval; IRLA, intrarectal local anesthestic; PPNB, periprostatic nerve block; SD, standard deviation.
Figure 6
Figure 6
Forest plot comparing PPNB + IPNB with PPNB. Abbreviations: CI, confidence interval; IPNB, intraprostatic nerve block; PPNB, periprostatic nerve block; SD, standard deviation.

References

    1. Autorino R, De Sio M, Di Lorenzo G, et al. How to decrease pain during transrectal ultrasound guided prostate biopsy: a look at the literature. J Urol. 2005;174(6):2091–2097.
    1. Ochiai A, Babaian RJ. Update on prostate biopsy technique. Curr Opin Urol. 2004;14:157–162.
    1. Nash PA, Bruce JE, Indudhara R, Shinohara K. Transrectal ultrasound guided prostatic nerve blockade eases systematic needle biopsy of the prostate. J Urol. 1996;155(2):607–609.
    1. Hergan L, Kashefi C, Parsons JK. Local anesthetic reduces pain associated with transrectal ultrasound-guided prostate biopsy: a meta-analysis. Urology. 2007;69(3):520–525.
    1. McCabe JE, Hanchanale VS, Philip J, Javle PM. A randomized controlled trial of topical glyceryl trinitrate before transrectal ultrasonography-guided biopsy of the prostate. BJU Int. 2007;100:536–538. discussion 538–539.
    1. Kandirali E, Ulukaradag E, Uysal B, Serin E, Semercioz A, Metin A. Is only perianal anesthesia with lidocaine–prilocaine cream sufficient to decrease the pain during transrectal ultrasound-guided prostate biopsy? A prospective randomized study. Urol Int. 2009;82(3):262–265.
    1. Gurbuz C, Canat L, Bayram G, Gokhan A, Samet G, Caskurlu T. Visual pain score during transrectal ultrasound-guided prostate biopsy using no anaesthesia or three different types of local anaesthetic application. Scand J Urol Nephrol. 2010;44(4):212–216.
    1. Adamakis I, Mitropoulos D, Haritopoulos K, Alamanis C, Stravodimos K, Giannopoulos A. Pain during transrectal ultrasonography guided prostate biopsy: a randomized prospective trial comparing periprostatic infiltration with lidocaine with the intrarectal instillation of lidocaine–prilocaine cream. World J Urol. 2004;22(4):281–284.
    1. Leung SY, Wong BB, Cheung MC, Ho KL, Lee FC, Tam PC. Intrarectal administration of lidocaine gel versus plain lubricant gel for pain control during transrectal ultrasound-guided extensive 10-core prostate biopsy in Hong Kong Chinese population: prospective double-blind randomised controlled trial. Hong Kong Med J. 2006;12(2):103–107.
    1. Song SH, Kim JK, Song K, Ahn H, Kim CS. Effectiveness of local anaesthesia techniques in patients undergoing transrectal ultrasound-guided prostate biopsy: a prospective randomized study. Int J Urol. 2006;13(6):707–710.
    1. Stirling BN, Shockley KF, Carothers GG, Maatman TJ. Comparison of local anesthesia techniques during transrectal ultrasound-guided biopsies. Urology. 2002;60(1):89–92.
    1. Trucchi A, De Nunzio C, Mariani S, Palleschi G, Miano L, Tubaro A. Local anesthesia reduces pain associated with transrectal prostatic biopsy. A prospective randomized study. Urol Int. 2005;74(3):209–213.
    1. Yurdakul T, Taspinar B, Kilic O, Kilinc M, Serarslan A. Topical and long-acting local anesthetic for prostate biopsy: a prospective randomized placebo-controlled study. Urol Int. 2009;83(2):151–154.
    1. Inal G, Yazici S, Adsan O, Ozturk B, Kosan M, Cetinkaya M. Effect of periprostatic nerve blockade before transrectal ultrasound-guided prostate biopsy on patient comfort: a randomized placebo controlled study. Int J Urol. 2004;11(3):148–151.
    1. Bingqian L, Peihuan L, Yudong W, Jinxing W, Zhiyong W. Intraprostatic local anesthesia with periprostatic nerve block for transrectal ultrasound guided prostate biopsy. J Urol. 2009;182(2):479–483.
    1. Manikandan R, Srirangam SJ, Brown SC, O’Reilly PH, Collins GN. Nitrous oxide vs periprostatic nerve block with 1% lidocaine during transrectal ultrasound guided biopsy of the prostate: a prospective, randomized, controlled trial. J Urol. 2003;170(5):1881–1883.
    1. Singh SK, Kumar A, Griwan MS, Sen J. Comparative evaluation of periprostatic nerve block with and without intraprostatic nerve block in transrectal ultrasound-guided prostatic needle biopsy. Korean J Urol. 2012;53(8):547–551.
    1. Seçkiner I, Sen H, Erturhan S, Yağcı F. A prospective, randomized controlled study comparing lidocaine and tramadol in periprostatic nerve blockage for transrectal ultrasound-guided prostate biopsy. Urology. 2011;78(2):257–260.
    1. Aktoz T, Kaplan M, Turan U, Memis D, Atakan IH, Inci O. ‘Multimodal’ approach to management of prostate biopsy pain and effects on sexual function: efficacy of levobupivacaine adjuvant to diclofenac sodium – a prospective randomized trial. Andrologia. 2010;42(1):35–40.
    1. Alavi AS, Soloway MS, Vaidya A, Lynne CM, Gheiler EL. Local anesthesia for ultrasound guided prostate biopsy: a prospective randomized trial comparing 2 methods. J Urol. 2001;166(4):1343–1345.
    1. Inal G, Adsan O, Ugurlu O, Kaygisiz O, Kosan M, Cetinkaya M. Comparison of four different anesthesia methods for relief of all pain during transrectal ultrasound-guided prostate biopsy. Int Urol Nephrol. 2008;40(2):335–339.
    1. Giannarini G, Autorino R, Valent F, et al. Combination of perianal-intrarectal lidocaine–prilocaine cream and periprostatic nerve block for pain control during transrectal ultrasound guided prostate biopsy: a randomized, controlled trial. J Urol. 2009;181(2):585–591.
    1. Noh DH, Cho MC, Park HK, Lee HW, Lee KS. The effects of combination perianal-intrarectal lidocaine–prilocaine cream and periprostatic nerve block for pain control during transrectal ultrasound guided biopsy of the prostate: a randomized, controlled trial. Korean J Urol. 2010;51(7):463–466.
    1. Obek C, Ozkan B, Tunc B, Can G, Yalcin V, Solok V. Comparison of 3 different methods of anesthesia before transrectal prostate biopsy: a prospective randomized trial. J Urol. 2004;172(2):502–505.
    1. Ooi WL, Hawks C, Tan AH, Hayne D. A randomised controlled trial comparing use of lignocaine periprostatic nerve block alone and combined with diclofenac suppository for patients undergoing transrectal ultrasound (TRUS)-guided prostate biopsy. BJU Int. 2014;114(suppl 1):45–49.
    1. Raber M, Scattoni V, Roscigno M, 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(5):967–973.
    1. Skriapas K, Konstantinidis C, Samarinas M, Xanthis S, Gekas A. Comparison between lidocaine and glyceryl trinitrate ointment for perianal-intrarectal local anesthesia before transrectal ultrasonography-guided prostate biopsy: a placebo-controlled trial. Urology. 2011;77(4):905–908.
    1. Szlauer R, Paras L, Fink KG. Addition of lidocaine suppositories to periprostatic nerve block enhances pain control in prostate biopsies: a placebo-controlled randomized trial. Urol Int. 2010;84(4):413–417.
    1. Yun TJ, Lee HJ, Kim SH, Lee SE, Cho JY, Seong CK. 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(1):103–106.
    1. Kumar A, Griwan MS, Singh SK, Sen J, Pawar DS. Is periprostatic nerve block a gold standard in case of transrectal ultrasound-guided prostate biopsy? Urol Ann. 2013;5(3):152–156.
    1. Lee HY, Lee HJ, Byun SS, Lee SE, Hong SK, Kim SH. Effect of intra-prostatic local anesthesia during transrectal ultrasound guided prostate biopsy: comparison of 3 methods in a randomized, double-blind, placebo controlled trial. J Urol. 2007;178(2):469–472.
    1. Tiong HY, Liew LC, Samuel M, Consigliere D, Esuvaranathan K. A meta-analysis of local anesthesia for transrectal ultrasound-guided biopsy of the prostate. Prostate Cancer Prostatic Dis. 2007;10(2):127–136.
    1. Obek C, Onal B, Ozkan B, Onder AU, Yalcin V, Solok V. Is periprostatic local anesthesia for transrectal ultrasound guided prostate biopsy associated with increased infectious or hemorrhagic complications? A prospective randomized trial. J Urol. 2002;168(2):558–561.
    1. Mutaguchi K, Shinohara K, Matsubara A, Yasumoto H, Mita K, Usui T. Local anesthesia during 10 core biopsy of the prostate: comparison of 2 methods. J Urol. 2005;173(3):742.
    1. Kaver I, Mabjeesh NJ, Matzkin H. Randomized prospective study of periprostatic local anesthesia during transrectal ultrasound-guided prostate biopsy. Urology. 2002;59(3):405–408.
    1. Schostak M, Christoph F, Muller M, et al. Optimizing local anesthesia during 10 core biopsy of the prostate. Urology. 2002;60(2):253.

Source: PubMed

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