Prostate biopsy: nerve block combination bests standard pain control

  • Aslan R & al.
  • Int J Urol
  • 17 Jun 2019

  • International Clinical Digest
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Takeaway

  • More effective pain control during prostate biopsy is possible using a combination of perineal pudendal nerve block and periprostatic nerve block (PPNB+PNB) instead of the standard method of periprostatic nerve block (PNB) alone, with similar complication rates and costs.

Why this matters

  • Discomfort or even severe pain can occur during prostate biopsy, increasing patient anxiety and affecting the success of the procedure.

Study design

  • Researchers in this prospective controlled trial randomly assigned patients with PSA ≥4 ng/mL or abnormal digital rectal examination findings to 1 of 3 treatment groups: PNB only (n=48), a combination of intrarectal local anesthesia and PNB (IRLA+PNB; n=51), or PPNB+PNB (n=49).
  • A different urologist who was blind to which anesthesia technique was used for each biopsy recorded patient-reported pain during the procedures, using a 0-10 scale.
  • Funding: None disclosed.

Key results

  • The mean pain score during insertion and manipulation of the transrectal ultrasound probe and for the procedure overall was significantly lower for the PPNB+PNB group (P<.001>
  • Procedure cost was significantly higher for the IRLA+PNB group.

Limitations

  • The study was single center with a small sample size.
  • Costs were calculated on the basis of invoices from a hospital in the Turkish healthcare system.

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