Comparative evaluation of bilateral pudendal nerve blockade and periprostatic nerve block in transrectal ultrasound guided prostate biopsy: a prospective randomised trial

Abstract

Introduction: Although the periprostatic nerve block (PNB) is accepted as the standard method for local anesthesia prior to transrectal ultrasound (TRUS)-guided prostate biopsy, it is not the most ideal method. We aimed to analyze the effectiveness and safety of bilateral pudendal nerve blockage (PuNB) by comparing with PNB.

Material and methods: Between June 2019 and October 2019, a total of 108 patients with elevated serum prostate specific antigen values (PSA ≥4 ng/ml) and/or abnormal digital rectal examination findings were included in the study. After exclusion criteria, the remaining 91 patients were randomly divided into two groups as PuNB (n = 46) and PNB (n = 45). Pain during local anesthesia application was recorded as a visual analog scale (VAS) 1, pain during placement of the rectal probe and manipulation was recorded as VAS 2 and pain during needle penetration into prostate tissue and sampling was recorded as VAS 3.

Results: No significant difference was found between the two groups with regard to age, body mass index, serum PSA, prostate volume and prostate cancer rates. Mean VAS-2 score was significantly lower in the PuNB group when compared with the PNB group. There was no significant difference in terms of VAS-1 and VAS-3 scores. There was no significant difference between the groups in terms of mild and severe complications.

Conclusions: Both techniques are safe for TRUS-guided prostate biopsy; however, PuNB provided more effective pain control compared to PNB especially during placement of rectal probe and manipulation.

Keywords: periprostatic nerve block; prostate biopsy; pudendal nerve blockage.

Figure 1

CONSORT flow-diagram for participants in the study.

Figure 2

Perineal anatomical landmarks for PuNB application (A), Left-sided PuNB application (B) and right-sided PuNB application (C).