To evaluate the analgesic effect of intrarectal local anesthesia (IRLA) versus that of periprostatic nerve block anesthesia (PPNB) in initial transrectal ultrasound-guided prostate biopsy (TRUS-PB) for patients with different prostate volumes (PV).
A total of 253 patients undergoing initial TRUS-PB in our hospital from January 2014 to November 2017 were divided into three PV groups (<50 ml, 50－100 ml, and >100 ml), each again randomized into three subgroups (control, IRLA, and PPNB) with the random number table method. The pain during the procedure was assessed based on the Visual Analogue Scale (VAS) scores and the blind method was used by the biopsy operator, VAS valuator and data analyst.
Among the patients with PV <50 ml, the VAS scores in the blank control, IRLA, and PPNB subgroups were 4.39±0.87, 3.51±0.84 and 3.43±1.07, respectively, remarkably higher in the control than in the IRLA and PPNB groups (P<0.05), but with no statistically significant differences between the latter two (P>0.05). Among those with PV of 50－100 ml, the VAS scores in the three subgroups were 4.50±1.05, 4.38±1.13 and 3.38±1.44, respectively, markedly higher in the control and IRLA than in the PPNB group (P<0.05), but with no statistically significant differences between the former two groups (P>0.05). Among those with PV >100 ml, the VAS scores in the three subgroups were 5.19±1.05, 5.00±1.25 and 4.19±0.91, respectively, remarkably higher in the former two groups than in the latter (P<0.05), but with no statistically significant differences between the former two groups (P>0.05).
Either IRLA or PPNB can be recommended for initial TRUS-PB in patients with PV <50 ml, PPNB for those with PV of 50－100 ml, and PPNB with other painkillers for those with PV >100 ml.
目的: 评价直肠腔内局部麻醉（IRLA）和前列腺周围神经阻滞麻醉(PPNB)在不同体积前列腺患者首次经直肠超声引导前列腺穿刺活检术（TRUS-PB）中疼痛控制的有效性，探讨针对不同前列腺体积的患者行TRUS-PB的合理麻醉镇痛方案。方法: 按照随机区组设计，将2014年1月至2017年11月为明确诊断而行首次TRUS-PB的患者253例按照前列腺体积分成<50 ml、50~100 ml、>100 ml 3组，每组患者采用随机数字表法分为空白对照组、IRLA组、PPNB组3个亚组。各组患者麻醉后行系统性TRUS-PB。穿刺后采用视觉模拟评分（VAS）对穿刺过程进行疼痛评分。本研究中，前列腺穿刺术者、VAS评分者与数据统计者实施盲法。结果: 前列腺体积<50 ml组内各亚组的VAS评分分别为(4.39±0.87)、(3.51±0.84)、(3.43±1.07)分，其中IRLA亚组与空白对照亚组、PPNB亚组与空白对照亚组的差异均有统计学意义（P<0.05），而IRLA亚组与PPNB亚组的差异无统计学意义（P>0.05）；前列腺体积50~100 ml组内各亚组的VAS评分分别为(4.50±1.05)、(4.38±1.13)、(3.38±1.44)分，其中IRLA亚组与空白对照亚组的差异无统计学意义（P>0.05），而PPNB亚组与空白对照亚组、PPNB亚组与IRLA亚组的差异均有统计学意义（P<0.05）；前列腺体积>100 ml组内各亚组的VAS评分分别为(5.19±1.05)、(5.00±1.25)、(4.19±0.91)分，IRLA亚组与空白对照亚组的差异无统计学意义（P>0.05），而PPNB亚组与空白对照亚组、PPNB亚组与IRLA亚组的差异均有统计学意义（P<0.05）结论： 对于首次TRUS-PB的患者，如前列腺体积<50 ml，建议行IRLA或PPNB麻醉；对于前列腺体积50~100 ml，推荐行PPNB麻醉；对于前列腺体积>100 ml，建议PPNB麻醉联合口服镇痛或IRLA。.
Zhonghua nan ke xue = National journal of andrology. 2018 May [Epub]
Ke-Ke Ding, Zhen-Yu Xu, Jie Zhang, Dong-Dong Yang, Bin Jiang, Ya Cao, Dong Zhuo
Department of Urology, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui 241001, China., Department of Pharmacy, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui 241001, China., Department of Anesthesiology, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui 241001, China.