两种不同局麻方法在经直肠前列腺穿刺活检术中的镇痛疗效比较

Comparing two methods of local anesthesia for transrectal ultrasound guided prostate biopsy

目的比较经直肠超声引导前列腺神经阻滞术和直肠内灌注2%利多卡因凝胶在前列腺穿刺活检术中的镇痛疗效。方法160例接受经直肠超声引导13点前列腺系统穿刺活检术的患者随机分为A、B两组。A组患者84例,在经直肠超声引导下,于前列腺基底部,左、右两侧精囊与前列腺交接处分别注射1%利多卡因5ml;B组患者76例,于活检前5min直肠内灌注2%利多卡因凝胶10ml。采用视觉模拟评分(VAS)评估两组患者在穿刺活检术中的疼痛程度。结果两组患者在平均年龄(t=0.73)、PSA水平(t=0.34)和前列腺体积(t=0.55)的差异无统计学意义(P>0.05),具有可比性。A组患者VAS评分0～3分者76例,4～5分者6例,6～10分者2例。B组患者则分别为48例、18例、10例。两组患者VAS评分均值分别为1.2分、2.6分,差异具有高度统计学意义(t=4.73,P<0.01)。两组患者均未出现局麻药的不良反应。结论经直肠超声引导前列腺神经阻滞术的镇痛疗效明显优于直肠内灌注2%利多卡因凝胶,值得临床推广应用。

Objective To compare the clinical efficacy of transreetal ultrasound guided prostatic nerve blockade with intrarectal 2% lidecaine gel for pain control during tmnsrectal prostate biopsy. Methods One hundred and sixty patients receiving systematic 13 cores biopsy of the prostate were divided randomly into two groups. Group A （84 eases） received an injection of 5 ml 1% lidoeaine into the prostatic neurovaseular btmdles on each side at the base of the prostate under ultrasound guidance. Group B （76 eases） received 10 ml of intrarectal 2% lideeaine gel 5 minutes before the procedure. Pain during biopsy was assessed using a 10 - point linear visual analog pain scale immediately after this procedure. Results Two groups were similar with respect to age, prostate- specific antigen level, and prostate volume. In group A,the VAS pain score of 0 to 3 was 76 cases,4 to 5 was 6 cases,6 to 10 was 2 cases. In group B,the VAS pain score of 0 to 3 was 48 cases, 4 to 5 was 18 eases,6 to 10 was 10 eases. The average pain scores during transreetal prostate biopsy in group A were significantly lower than that of group B （ 1.2 vs 2.6, t = 4.73, P 〈 0.01 ）. No patient in either group had any adverse effect from the injection during the procedure. Conclusions Transreetal ultrasound guided prostatic nerve bleckade provides anesthesia superior to the intrareetal lidoeaine gel during transrectal prostate biopsy. Its routine administration in all patients during this procedure.