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Comparison of traditional basal and apical periprostatic block: impact on injection pain and biopsy pain
Author(s) -
Nguyen Carvell T.,
Jones J. Stephen
Publication year - 2007
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2006.06652.x
Subject(s) - biopsy , lidocaine , medicine , visual analogue scale , prostate biopsy , nerve block , basal (medicine) , surgery , urology , prostate , anesthesia , radiology , cancer , insulin
OBJECTIVE To compare the pain of injection and biopsy when lidocaine is injected periprostatically either at a basal or apical site, as the former is commonly used to anaesthetise the prostate, based on several reports showing that it can eliminate most of the pain associated with prostate biopsy, and this site has been favoured over apical injection because the nerves enter the prostate from the basal aspect. PATIENTS AND METHODS In all, 143 patients scheduled for biopsy were randomized to receive a periprostatic block either at the apex or base of the prostate. Immediately before biopsy 5 mL of 1% lidocaine was injected under transrectal ultrasonographic (TRUS) guidance into the periprostatic nerves bilaterally. Patients were immediately given a 100 mm visual analogue scale (VAS, 0–100) to assess the pain associated with both the block and the subsequent biopsy. RESULTS The mean VAS scores for the anaesthetic block were 21.1 and 22.0 ( P = 0.79) and the biopsy VAS scores were 17.6 and 28.7 ( P < 0.001) for the apical and basal groups, respectively. There was no statistically significant difference between patients who had a 12‐ or 20‐core biopsy. CONCLUSIONS Apical periprostatic injection with anaesthetic provides better anaesthesia for TRUS biopsy than basal injection, and without increasing the pain associated with injection at the potentially more sensitive apical site.