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Ueda N, Sato M, Mori S, Matsukawa A, Oki Y, Kujime Y, Mizuno R, Horitani H, Yamamoto T, Fukae S, Yoshinaga M, Matsushita M, Akiyama M, Kamido S, Honda A, Nakayama J, Tei N, Miyake O. Lower Dose of 5 mL of 1% Lidocaine is More Suitable than the Conventional 10 mL for Caudal Block in Transrectal Prostate Biopsy: A Retrospective Cohort Study. Adv Urol 2024; 2024:9331738. [PMID: 38389652 PMCID: PMC10881246 DOI: 10.1155/2024/9331738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 02/04/2024] [Accepted: 02/06/2024] [Indexed: 02/24/2024] Open
Abstract
Objectives In Japan, caudal block with 1% lidocaine is commonly used for transrectal prostate biopsy. Although 10 mL of 1% lidocaine is commonly used, the appropriate dosage of 1% lidocaine has not been studied. Our hospital routinely uses two different doses (5 or 10 mL) of 1% lidocaine for caudal block for transrectal prostate biopsy. Herein, we retrospectively evaluated the efficacy and safety of both doses of 1% lidocaine. Methods This retrospective study included 869 patients who underwent transrectal prostate biopsy with caudal block at our hospital. The amount of 1% lidocaine was determined by the day of the week on which the biopsy was performed, and the patient voluntarily chose the day of the biopsy, unaware of the dose of 1% lidocaine used on that day. Pain, anal sphincter tonus, cancer diagnosis rate, and early complications were compared. Results In total, 466 and 403 patients received 5 and 10 mL of 1% lidocaine for a caudal block, respectively. After propensity-score matching for patient characteristics, each group contained 395 patients. The pain score, anal sphincter tonus score, or prostate cancer diagnosis rate were not significantly different between the two groups. However, rectal bleeding was significantly more frequent and severe in the 10-mL than the 5-mL group (p=0.018 and p=0.0036, respectively). The incidence of other complications was not significantly different between the groups. Conclusions Our results suggest that 5 mL of 1% lidocaine may be more suitable than 10 mL for caudal block during transrectal prostate biopsy.
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Affiliation(s)
- Norichika Ueda
- Department of Urology, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka 560-8565, Japan
| | - Mototaka Sato
- Department of Urology, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka 560-8565, Japan
| | - Shunsuke Mori
- Department of Urology, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka 560-8565, Japan
| | - Atsuki Matsukawa
- Department of Urology, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka 560-8565, Japan
| | - Yuta Oki
- Department of Urology, Osaka Rosai Hospital, 1179-3 Nagasanecho, Kita-ku, Sakai, Osaka 591-8025, Japan
| | - Yuma Kujime
- Department of Urology, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka 560-8565, Japan
| | - Ryoya Mizuno
- Department of Urology, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka 560-8565, Japan
| | - Hiromu Horitani
- Department of Urology, Higashiosaka City Medical Center, 3-4-5 Nishiiwata, Higashiosaka, Osaka 587-8588, Japan
| | - Tetsuya Yamamoto
- Department of Urology, Ikeda City Hospital, 3-1-18 Jonan, Ikeda, Osaka 563-8510, Japan
| | - Shota Fukae
- Department of Urology, Hyogo Prefectural Nishinomiya Hospital, 13-9 Rokutanjicho, Nishinomiya, Hyogo 662-0918, Japan
| | - Mitsuhiro Yoshinaga
- Department of Urology, Minoh City Hospital, 5-7-1 Kayano, Minoh, Osaka 562-0014, Japan
| | - Makoto Matsushita
- Department of Urology, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka 560-8565, Japan
| | - Mai Akiyama
- Department of Urology, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka 560-8565, Japan
| | - Satoshi Kamido
- Pharmaceuticals and Medical Devices Agency, 3-3-2 Kasumigaseki, Chiyoda-ku, Tokyo 100-0013, Japan
| | - Ayako Honda
- Department of Anesthesiology, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka 560-8565, Japan
| | - Jiro Nakayama
- Department of Urology, Suita Tokushukai Hospital, 21-1 Senriokanishi, Suita, Osaka 565-0814, Japan
| | - Norihide Tei
- Department of Urology, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka 560-8565, Japan
| | - Osamu Miyake
- Department of Urology, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka 560-8565, Japan
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Fasola OA, Takure AO, Shittu OB. Transrectal ultrasound-guided prostate biopsy: periprostatic block versus caudal block for analgesia—a randomized trial. AFRICAN JOURNAL OF UROLOGY 2021. [DOI: 10.1186/s12301-021-00185-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Transrectal ultrasound (TRUS)-guided prostate biopsy is a potentially painful procedure, due to the insertion of the TRUS probe in the anus and multiple passes of the biopsy needle through the rectum and prostate. Several methods of reducing pain and discomfort have been described. These include intra-rectal local anaesthetic gel (IRLA) instillation, periprostatic nerve block (PPNB), caudal block (CB) and oral analgesics. CB has potential complications of dural puncture and anaesthetic failure, while PPNB may be complicated by intravascular injection with systemic local anaesthetic toxicity. Only few studies have compared transrectal PPNB with CB with equivocal results. This study compared transrectal PPNB to CB in terms of efficacy of analgesia and incidence of complications.
Methods
A prospective randomized clinical trial was carried out among 80 consenting patients with an indication for TRUS-guided prostate biopsy in the Urology division of [BLINDED FOR PEER REVIEW]. Eighty participants were each randomized to either of Group A (CB with 10 ml of 2% lidocaine) or Group B (PPNB with a total of 20 ml of 1% lidocaine). Pain was assessed using an 11-point numerical rating scale (NRS), and questions on satisfaction with the procedure and willingness for a repeat procedure were asked. The incidence of complications was also recorded.
Results
There were no significant differences in the mean ages, body mass indices (BMIs), prostate-specific antigen (PSA) levels, digital rectal examination (DRE) findings and prostate sizes between the two groups. The mean NRS scores at administration of block, insertion of TRUS probe, prostate biopsy, 30 min and 1 day after biopsy were 2.9 ± 2.3, 2.1 ± 2.2, 3.1 ± 2.6, 1.4 ± 2.2 and 0.2 ± 0.4 respectively for CB and 3.1 ± 2.2, 2.3 ± 1.2, 2.8 ± 2.7, 1.4 ± 1.7 and 0.3 ± 0.5, respectively, for the PPNB group. There were no significant differences between the mean scores in both groups. There were also no statistically significant differences in the incidences of complications in both groups.
Conclusion
The two methods of analgesia are similar in efficacy and are equally safe to employ in the performance of TRUS-guided prostate biopsy. Both methods can be learned to increase the repertoire of the urologist when faced with a TRUS-guided prostate biopsy.
Trial registration
PACTR, PACTR202012779661309. Registered 11th December 2020—Retrospectively registered, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=14564.
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Demirtaş A, Sönmez G, Tombul ŞT, Demirtaş T. Comparison of pain levels in fusion prostate biopsy and standard TRUS-Guided biopsy. Int Braz J Urol 2020; 46:557-562. [PMID: 32213209 PMCID: PMC7239274 DOI: 10.1590/s1677-5538.ibju.2019.0154] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 10/06/2019] [Indexed: 11/30/2022] Open
Abstract
Objectives Fusion prostate biopsy (FPB) has recently emerged as a popular and successful biopsy technique on diagnosis of prostate cancer. The aim of this study was to compare the pain levels in TRUS-guided standard 12-core prostate biopsy (SPB) and MpMRI-guided FPB. Materials and Methods Patients detected with a PI-RADS (Prostate Imaging Reporting and Data System) ≥3 lesion on MpMRI underwent MpMRI-guided FPB (Group I) and the patients who had no suspected lesions or had a PI-RADS <3 lesion on MpMRI underwent TRUS-guided SPB (Group II). Pain assessment was performed using Visual Analog Scale (VAS) five minutes after the procedure. Following the procedure, the patients were asked to indicate the most painful biopsy step among the three steps. Results 252 patients were included in this study (Group I=159, Group II=93). The mean number of cores and the malignancy detection rate were significantly higher in Group I compared to Group II (p <0.001, p=0.043, respectively). No significant difference was found between the two groups with regard to VAS scores (p=0.070). The most painful part of the whole procedure was revealed to be the insertion of the probe into the rectum. However, no significant difference was found between the two groups with regard to the most painful biopsy step (p=0.140). Conclusion FPB, with a relatively higher cancer detection rate, leads to the same pain level as SPB although it increases the number of biopsy cores and involves a more complex procedure compared to SPB. Further prospective studies with larger patient series are needed to substantiate our findings.
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Affiliation(s)
| | - Gökhan Sönmez
- Department of Urology, Kayseri City Hospital, Kayseri, Turkey
| | | | - Türev Demirtaş
- Department of Medical History and Ethics, Erciyes University, Kayseri, Turkey
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Ding XF, Luan Y, Wang F, Xu YZ, Guo CH, Zhu LY. The application of a targeted periprostatic nerve block in transperineal template-guided prostate biopsies. Quant Imaging Med Surg 2020; 10:2125-2132. [PMID: 33139992 DOI: 10.21037/qims-20-369] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Our study aims to evaluate the anesthetic efficacy of multiparametric magnetic resonance imaging/transrectal ultrasound (mpMRI/TRUS) fusion-guided targeted periprostatic nerve block (PNB) for transperineal template-guided prostate biopsy (TTPB). Methods The patients who underwent mpMRI/TRUS fusion-guided prostate biopsy from May 2018 to March 2019 were randomized into two groups using a random number table. The intervention group (n=47) and the control group (n=45) received targeted PNB and traditional PNB, respectively. Visual analog scale (VAS) and visual numeric scale (VNS) scores were used to assess the patients' pain and quantify their satisfaction. Results The total detection rate for prostate cancer was 45.7%, with a comparable positive rate between the intervention group (42.6%) and the control group (48.9%), which meant there was no significant difference between the groups (P=0.542). Patient age, prostate-specific antigen, prostate volume, suspicious lesions on mpMRI, number of cores, operation time, and biopsy time were comparable between the groups. The VAS scores during biopsy were significantly lower in the intervention group than in the control group [2 (1 to 3) vs. 2 (1 to 4), P=0.019]. Conversely, the VNS scores during biopsy were higher in the intervention group [3 (2 to 4) vs. 3 (2 to 3), P=0.015]. There were no significant differences in the pain scores or the satisfaction scores at 30 min after the procedure between the two groups. There were no significant differences between the groups for complications, such as hematuria, urinary retention, infection, hemospermia, and vasovagal reaction (P>0.05). Conclusions Targeted PNB significantly relieved the pain and did not increase the incidence of complications for patients when compared with traditional PNB.
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Affiliation(s)
- Xue-Fei Ding
- Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Yang Luan
- Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Fei Wang
- Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Yao-Zong Xu
- Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Cheng-Hao Guo
- Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Liang-Yong Zhu
- Clinical Medical College, Yangzhou University, Yangzhou, China
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Aslan R, Erbin A, Celik S, Ucpinar B, Eryilmaz R, Taken K. Periprostatic nerve block alone versus combined with perineal pudendal nerve block or intrarectal local anesthesia during transrectal ultrasound-guided prostate biopsy: A prospective randomized controlled trial. Int J Urol 2019; 26:833-838. [PMID: 31209957 DOI: 10.1111/iju.14036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 05/12/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To compare the efficacy, safety and cost of combinations of perineal pudendal nerve block + periprostatic nerve block and intrarectal local anesthesia + periprostatic nerve block with the standard technique (periprostatic nerve block). METHODS The study was designed as a randomized prospective controlled trial. Patients with elevated serum prostate-specific antigen values (prostate-specific antigen ≥4 ng/mL) and/or abnormal digital rectal examination findings were included in the study. Patients with anorectal diseases, chronic prostatitis, previous history of prostate biopsy and anorectal surgery were excluded from the study. A total of 148 patients (group 1 [periprostatic nerve block], n = 48; group 2 [intrarectal local anesthesia + periprostatic nerve block], n = 51; group 3 [perineal pudendal nerve block + periprostatic nerve block], n = 49) were included in the final analysis. Pain during insertion and manipulation of the transrectal ultrasound probe was recorded as visual analog scale 1, pain during penetration of the biopsy needle into the prostate and sampling was recorded as visual analog scale 2, and pain during the entire procedure recorded as visual analog scale 3. RESULTS The mean visual analog scale 1 score was significantly lower in group 3, when compared with group 1 and group 2 (P < 0.001). There was no significant difference between the groups in terms of the mean visual analog scale 2 score. The mean visual analog scale 3 score was significantly lower in group 3 when compared with other groups (P < 0.001). The total cost for transrectal ultrasound-guided biopsy in the intrarectal local anesthesia + periprostatic nerve block group was significantly higher than the other two groups. CONCLUSIONS The combination of perineal pudendal nerve block and periprostatic nerve block provides more effective pain control than intrarectal local anesthesia plus periprostatic nerve block and periprostatic nerve block alone, with similar complication rates and without increasing cost.
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Affiliation(s)
- Rahmi Aslan
- Department of Urology, Yuzuncu Yil University Medical Faculty, Van, Turkey
| | - Akif Erbin
- Department of Urology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Sebahattin Celik
- Department of General Surgery, Yuzuncu Yil University Medical Faculty, Van, Turkey
| | - Burak Ucpinar
- Department of Urology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Recep Eryilmaz
- Department of Urology, Yuzuncu Yil University Medical Faculty, Van, Turkey
| | - Kerem Taken
- Department of Urology, Yuzuncu Yil University Medical Faculty, Van, Turkey
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