Presentation Authors: Joao Pimentel Torres*, Adriana Rodrigues, Paulo Mota, Agostinho Cordeiro, Nuno Morais, Sara Anacleto, Antonio Pedro Carvalho, Ricardo Matos Rodrigues, Ricardo Leão, Estevao Lima, Braga, Portugal
Introduction: Transrectal ultrasound-guided (TRUS) biopsy is the gold standard for prostate cancer diagnosis. This invasive procedure is generally associated with pain and discomfort. Currently, the periprostatic nerve block is the most used technique for pain control. However, there is still some controversy about where and what type of analgesic should be performed. The aim of this study was to evaluate the benefit of adding local periapical prostatic anesthesia to the traditional periprostatic nerve block during TRUS biopsy.
Methods: A prospective study was performed and a total of 70 patients with indication for TRUS biopsy were enrolled. Patients were randomized into 2 groups. The control group received 5 ml of 1% lidocaine at the junction of the prostate with seminal vesicles bilaterally. The other group, which is referred from now on as the â€œperiapical groupâ€ received 3 ml of 1% lidocaine at the junction of the prostate with seminal vesicles and 2 ml of the same anesthetic at the prostatic apex bilaterally. The pain experienced during different moments of the procedure (introduction of the ultrasound probe, anesthesia administration, removal of prostatic fragments and 30 minutes after finishing biopsy) was assessed using visual analog scales of one to ten. The rate of complications at 30 days post-biopsy was also assessed.
Results: There were no significant differences concerning age, level of total PSA and prostate volume and pathological findings (detection of malignancy and positive cores) in both groups. The difference in pain during the distinct moments of TRUS biopsy was not significant between the two groups. Particularly, during the administration of anesthesia, the pain levels were similar, with a mean of 1,92 in the periapical group and 1,63 in the control group (p=0.772). No statistically significant differences were observed between the groups regarding the occurrence of complications, most importantly hematuria and/or urethral bleeding (7 patients (20%) in the control group and 5 (14,3%) in the periapical group; p=0,520).
Conclusions: Periprostatic and periapical nerve block does not improve pain control when compared to the periprostatic nerve block alone.