前列腺周围神经阻滞麻醉对缓解经直肠超声引导下前列腺穿刺活检术疼痛的效果

Efficacy of periprostatic nerve block anesthesia for pain control in transrectal ultrasoundguided systematic prostate biopsy

目的：评估前列腺周围神经阻滞麻醉（PPNB）对缓解经直肠超声引导下前列腺穿刺活检术时疼痛的效果。方法回顾性分析我院2013年11月~2015年1月经直肠超声引导下前列腺12针系统穿刺患者111例，根据是否采用PPNB，将患者分成PPNB组（52例）和非PPNB组（59例）。PPNB组在经直肠超声引导下注射1％利多卡因阻滞麻醉前列腺周围神经，然后行穿刺活检；非PPNB组未采用任何麻醉方法。穿刺结束后采用视觉模拟评分法对直肠指检（DRE）、经直肠超声检查、穿刺过程进行疼痛评分；穿刺结束后7天随访患者穿刺并发症。结果两组患者的年龄、前列腺体积、总前列腺特异性抗原（TPSA）、游离前列腺特异性抗原（FPSA）、DRE异常比例差异无统计学意义。两组患者DRE疼痛评分（1.40∶1.39，P=0.997）、经直肠超声检查疼痛评分（2.10∶2.07，P=0.834）差异无统计学意义；然而，PPNB组穿刺疼痛评分更低（2.54∶3.07，P=0.033）。两组患者穿刺并发症差异无统计学意义。结论相对于无麻醉，采用前列腺周围神经阻滞麻醉可减轻经直肠超声引导下前列腺穿刺活检术时疼痛不适。

Objective To evaluate the efficacy of periprostatic nerve block anesthesia （PPNB） for pain relief in transrectal ultrasound-guided systematic prostate biopsy （PBx）. Methods We reviewed the data of patients undergoing initial PBx at our center from November, 2013 to January, 2015. Only the patients with 12-core systemic PBx were included and 111 patients were eligible for this study, among whom 52 patients received PPNB and 59 did not. PPNB was achieved by an injection of 5 mL of 1%lidocaine at the angle between the seminal vesicle and base of the prostate on each side before biopsy. The DRE pain score, probe insert pain score, and biopsy pain score were assessed by visual analogue scale （VAS） immediately after the biopsy. The complications were recorded and evaluated immediately after and at 7 days after the biopsy. Results The mean age, prostate volume, total prostate specific antigen （tPSA）, free PSA （fPSA）, and abnormal DRE were comparable between the 2 groups （P〉0.05）. Immediately after the biopsy, no difference was found between the 2 groups in DRE pain score （1.40±0.98 vs 1.39±0.91, P=0.102） or probe insert pain score （2.07±0.96 vs 2.03±0.90, P=0.960）, but the biopsy pain score was significantly lower in PPNB group than in no PPNB group （2.54±1.42 vs 3.07±1.43, P=0.033）. The incidence of the procedure-related complications was similar between the 2 groups （P〉0.05）. Conclusion PPNB can significantly lower the biopsy pain score in PBx without increasing the incidence of complications.