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TENS as an Adjunct to Local Anaesthesia During Transperineal Prostate Biopsy: A Randomized Sham-Controlled Trial (TENS 2)

2026년 5월 5일 업데이트: Bartłomiej Marczak, Medical University of Gdansk

Transcutaneous Electrical Nerve Stimulation as an Adjunct to Local Anaesthesia During Transperineal MRI-Ultrasound Fusion-Guided Prostate Biopsy: A Randomized Triple-Blind Sham-Controlled Trial

Transperineal prostate biopsy is a safe and effective method of diagnosing prostate cancer. When performed under local anaesthesia in an outpatient setting, it can cause significant pain, particularly during the periprostatic nerve block - the injection of local anaesthetic around the prostate. Better pain management during this procedure may improve patient comfort and encourage wider use of the transperineal approach.

Transcutaneous electrical nerve stimulation (TENS) is a non-invasive, low-cost method of pain relief that works by delivering mild electrical impulses through the skin. A preceding pilot study at our centre (n=84) found that TENS used alongside local anaesthesia was associated with significantly lower pain scores during periprostatic nerve block and biopsy sampling, with no device-related complications.

This study aims to confirm these findings in a larger, formally powered, triple-blind, randomized controlled trial. Participants will be randomly assigned to receive either active TENS or sham TENS (electrodes applied but no electrical current delivered) in addition to standard local anaesthesia. Neither the participant, the operating urologist, nor the nurse recording pain scores will know which group the participant is in.

Pain intensity will be assessed at four stages of the procedure using a 0-10 numeric rating scale. Participants will be followed up at 30 days after the biopsy.

연구 개요

상태

아직 모집하지 않음

정황

개입 / 치료

상세 설명

This is a single-centre, prospective, randomized, triple-blind, sham-controlled, two-parallel-group superiority trial. The study builds on a preceding pilot study (TENS 1, n=84) which demonstrated large effect sizes for TENS-associated pain reduction during transperineal prostate biopsy under local anaesthesia.

Triple-blinding is achieved through a three-component procedure: amplitude titration is completed before the operating urologist enters the procedure room; a physical opaque screen is placed between the TENS device and the operative field; and participants are instructed not to verbalise device-related sensations during the procedure.

The primary outcome is NRS pain score during periprostatic nerve block, assessed within 30 seconds of completion of bilateral periprostatic infiltration by an independent outcome assessor blinded to allocation.

Exploratory outcomes include preoperative pain catastrophizing, preoperative anxiety (STAI-S), and the effect of prior biopsy experience on procedural pain.

연구 유형

중재적

등록 (추정된)

140

단계

  • 해당 없음

연락처 및 위치

이 섹션에서는 연구를 수행하는 사람들의 연락처 정보와 이 연구가 수행되는 장소에 대한 정보를 제공합니다.

연구 연락처

연구 장소

  • 폴란드
    • Pomeranian Voivodeship
      • Gdansk, Pomeranian Voivodeship, 폴란드, 80-214
        • Department of Urology, Medical University of Gdansk
        • 연락하다:

참여기준

연구원은 적격성 기준이라는 특정 설명에 맞는 사람을 찾습니다. 이러한 기준의 몇 가지 예는 개인의 일반적인 건강 상태 또는 이전 치료입니다.

자격 기준

공부할 수 있는 나이

  • 성인
  • 고령자

건강한 자원 봉사자를 받아들입니다

아니

설명

Inclusion Criteria:

  • Male patients aged 40 years or older
  • Indication for prostate biopsy: elevated serum PSA (as per institutional protocol and EAU guidelines) or abnormal digital rectal examination (DRE)
  • Suspicious lesion on multiparametric MRI classified as PI-RADS score 3 or higher (version 2.1)
  • Scheduled for transperineal MRI-ultrasound fusion-guided prostate biopsy under local anaesthesia
  • Ability to provide written informed consent

Exclusion Criteria:

  • Prior treatment for prostate cancer (surgical, radiotherapy, hormonal or focal therapy)
  • Contraindications to TENS: cutaneous damage or dermatologic conditions at electrode application sites; cardiac pacemaker or implantable cardioverter-defibrillator (ICD); uncontrolled cardiac arrhythmia or congestive heart failure; history of epilepsy or seizure disorder; metallic implants near the stimulation site; malignancy at or near the stimulation site
  • Contraindications to transperineal biopsy: active urinary tract infection; bleeding disorder or ongoing anticoagulation not amendable to bridging; anatomical abnormalities preventing safe prostatic access
  • Known allergy or intolerance to local anaesthetic agents or biopsy-related materials
  • Severe comorbidities or unstable medical condition compromising procedural safety
  • Inability to complete questionnaires
  • Participation in another interventional clinical trial within 30 days prior to enrolment

공부 계획

이 섹션에서는 연구 설계 방법과 연구가 측정하는 내용을 포함하여 연구 계획에 대한 세부 정보를 제공합니다.

연구는 어떻게 설계됩니까?

디자인 세부사항

  • 주 목적: 지지 요법
  • 할당: 무작위
  • 중재 모델: 병렬 할당
  • 마스킹: 네 배로

무기와 개입

참가자 그룹 / 팔
개입 / 치료
실험적: Active TENS
Participants receive active transcutaneous electrical nerve stimulation (TENS) initiated 3-5 minutes before local anaesthesia, using Cefar Rehab X2 device (Class II, Type BF). Parameters: symmetrical biphasic compensated pulse, 80 Hz, 180 µs pulse duration, amplitude individually titrated to highest comfortably tolerable level. Two pairs of 5x5 cm electrodes placed in the perineal region. TENS continued throughout all procedural stages and discontinued after biopsy sampling. Standard local anaesthesia administered to all participants: 10 mL 2% lignocaine gel transrectally, followed by 20 mL 1% lignocaine using full needle-path infiltration technique.
장치: Transcutaneous Electrical Nerve Stimulation (TENS)
Cefar Rehab X2 device (Class II, Type BF). Symmetrical biphasic compensated pulse; 80 Hz; 180 µs pulse duration; amplitude individually titrated. Two pairs of 5x5 cm electrodes in perineal region. Initiated 3-5 minutes before local anaesthesia, continued throughout procedure.
가짜 비교기: Sham TENS
Participants receive sham TENS. Electrodes placed identically to the active group. Device activated in identical manner but delivers no electrical current. Device display not visible to participant; device produces no sound. Standard local anaesthesia identical to active group.
장치: Sham Transcutaneous Electrical Nerve Stimulation
Identical electrode placement to active group. Device activated without delivering electrical current. Indistinguishable from active TENS by participant, operator, and outcome assessor.

연구는 무엇을 측정합니까?

주요 결과 측정

결과 측정
측정값 설명
기간
NRS Pain Score During Periprostatic Nerve Block
기간: Immediately after completion of periprostatic nerve block (intraoperative)
Patient-reported pain intensity during periprostatic nerve block (PNB), assessed using a Numeric Rating Scale (NRS, 0-10, where 0 = no pain and 10 = worst imaginable pain). PNB consists of periprostatic infiltration ( 10 mL 1% lignocaine under real-time ultrasound guidance). NRS assessed verbally by an independent outcome assessor (Nurse B) within 30 seconds of completion of the PNB injection, before the next procedural stage begins. Standardised verbal NRS explanation provided to all participants before the procedure.
Immediately after completion of periprostatic nerve block (intraoperative)

2차 결과 측정

결과 측정
측정값 설명
기간
NRS Pain Score During Ultrasound Probe Insertion
기간: Immediately after ultrasound probe insertion (intraoperative)
NRS (0-10) assessed within 30 seconds of probe placement, before local anaesthesia administration begins.
Immediately after ultrasound probe insertion (intraoperative)
NRS Pain Score During Perineal Infiltration
기간: Immediately after perineal infiltration (intraoperative)
NRS (0-10) assessed within 30 seconds of completion of perineal skin and subcutaneous tissue local anaesthetic infiltration.
Immediately after perineal infiltration (intraoperative)
NRS Pain Score During Biopsy Sampling
기간: Immediately after fusion-targeted biopsy sampling (intraoperative)
NRS (0-10) assessed within 30 seconds of the last biopsy core being obtained.
Immediately after fusion-targeted biopsy sampling (intraoperative)
Procedural Safety and Tolerability
기간: Through 30-day follow-up
Incidence and severity of adverse events classified per Clavien-Dindo grading system.
Through 30-day follow-up
Willingness to Repeat the Procedure
기간: 30-day follow-up visit
Single question (yes/no/unsure) assessing patient willingness to undergo the same procedure in the future.
30-day follow-up visit
Blinding Integrity - James Blinding Index
기간: Immediately after biopsy sampling, before unblinding
Participant blinding assessed by single question posed by independent outcome assessor immediately after biopsy sampling: which group the participant believes they were assigned to (active/sham/no opinion), plus certainty rating (1-5).
Immediately after biopsy sampling, before unblinding
Operator Satisfaction
기간: Immediately after procedure
Single-item Likert scale (1-5, where 1 = very dissatisfied and 5 = very satisfied with procedural conditions), recorded by the operating urologist immediately after the procedure, assessing overall satisfaction with procedural conditions during the biopsy.
Immediately after procedure
Patient Satisfaction
기간: Immediately after procedure
Single-item Likert scale (1-5, where 1 = very dissatisfied and 5 = very satisfied), recorded immediately after procedure by independent outcome assessor.
Immediately after procedure
Amsterdam Preoperative Anxiety and Information Scale
기간: Administered before the procedure.
Amsterdam Preoperative Anxiety and Information Scale (APAIS; 6 items; Moerman et al., Anesth Analg 1996;82: 445-451; Polish forward-backward translation). Administered before the procedure. Association with primary outcome assessed by Spearman correlation as covariate.
Administered before the procedure.
NRS-Anxiety
기간: Administered before the procedure and immediately after biopsy sampling to assess pre-to-post procedural anxiety change.
NRS-Anxiety (0-10; single item: "How anxious are you right now?"). Administered before the procedure and immediately after biopsy sampling to assess pre-to-post procedural anxiety change. Pre-to-post delta reported as exploratory outcome.
Administered before the procedure and immediately after biopsy sampling to assess pre-to-post procedural anxiety change.
TENS Amplitude vs Pain Reduction
기간: Intraoperative (active group only)
Actual TENS amplitude used (mA) recorded for each participant in the active group. Spearman correlation between amplitude and NRS reduction during PNB.
Intraoperative (active group only)
Pain Catastrophizing Scale (PCS-13)
기간: Before the procedure
Pain Catastrophizing Scale (Sullivan et al., Psychol Assess 1995;7:524-532). 13-item self-report questionnaire, score 0-52. Three subscales: rumination, magnification, helplessness. Polish version available. Administered before the procedure as covariate for primary outcome analysis.
Before the procedure

공동 작업자 및 조사자

여기에서 이 연구와 관련된 사람과 조직을 찾을 수 있습니다.

스폰서

Medical University of Gdansk

연구 기록 날짜

이 날짜는 ClinicalTrials.gov에 대한 연구 기록 및 요약 결과 제출의 진행 상황을 추적합니다. 연구 기록 및 보고된 결과는 공개 웹사이트에 게시되기 전에 특정 품질 관리 기준을 충족하는지 확인하기 위해 국립 의학 도서관(NLM)에서 검토합니다.

연구 주요 날짜

연구 시작 (추정된)

2026년 6월 1일

기본 완료 (추정된)

2027년 1월 1일

연구 완료 (추정된)

2027년 2월 1일

연구 등록 날짜

최초 제출

2026년 5월 3일

QC 기준을 충족하는 최초 제출

2026년 5월 5일

처음 게시됨 (실제)

2026년 5월 11일

연구 기록 업데이트

마지막 업데이트 게시됨 (실제)

2026년 5월 11일

QC 기준을 충족하는 마지막 업데이트 제출

2026년 5월 5일

마지막으로 확인됨

2026년 5월 1일

추가 정보

이 연구와 관련된 용어

키워드

추가 관련 MeSH 약관

기타 연구 ID 번호

  • TENS2-TPB-RCT-2026

개별 참가자 데이터(IPD) 계획

개별 참가자 데이터(IPD)를 공유할 계획입니까?

예

IPD 계획 설명

De-identified individual participant data underlying the results reported in the primary publication will be made publicly available at the Open Science Framework (OSF) at the time of publication.

IPD 공유 기간

Beginning at time of publication, no end date.

IPD 공유 액세스 기준

Publicly available without restriction via Open Science Framework (OSF).

IPD 공유 지원 정보 유형

  • 연구_프로토콜
  • 수액
  • ICF
  • ANALYTIC_CODE

약물 및 장치 정보, 연구 문서

미국 FDA 규제 의약품 연구

아니

미국 FDA 규제 기기 제품 연구

아니

이 정보는 변경 없이 clinicaltrials.gov 웹사이트에서 직접 가져온 것입니다. 귀하의 연구 세부 정보를 변경, 제거 또는 업데이트하도록 요청하는 경우 register@clinicaltrials.gov. 문의하십시오. 변경 사항이 clinicaltrials.gov에 구현되는 즉시 저희 웹사이트에도 자동으로 업데이트됩니다. .

통증, 시술에 대한 임상 시험

Transcutaneous Electrical Nerve Stimulation (TENS)에 대한 임상 시험

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스폰서 및 공동 작업자

건강 상태

약물 개입

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정황

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약물 개입

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스폰서 / 협력자

위치

구독하다