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.
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.
['Aslan|Rahmi|R|', 'Erbin|Akif|A|', 'Celik|Sebahattin|S|', 'Ucpinar|Burak|B|', 'Eryilmaz|Recep|R|', 'Taken|Kerem|K|']
D000368:Aged D000772:Anesthesia, Local D000779:Anesthetics, Local D062005:Biopsy, Large-Core Needle D003362:Cost-Benefit Analysis D006801:Humans D061705:Image-Guided Biopsy D008012:Lidocaine D008297:Male D008875:Middle Aged D009407:Nerve Block D010147:Pain Measurement D000073818:Pain, Procedural D011467:Prostate D011471:Prostatic Neoplasms D060525:Pudendal Nerve D012007:Rectum D018084:Ultrasonography, Interventional
periprostatic nerve block intrarectal local anesthesia prostate biopsy pudendal nerve blockade