title: Periprostatic nerve block before ultrasound-guided prostate biopsy: a comparison of two local anesthetics.
abstract: The objective of the present study was to evaluate the efficacy of the periprostatic nerve block (PNB) of the prostate-vesicular junction with low volume and high concentration of anesthetics in relieving pain during prostate biopsy. Two hundred and twenty patients were enrolled and randomized to receive PNB with 5 ml 2% lidocaine (group 1110 pts) and PNB with 5 ml 2% mepivacaine (group 2, 110 pts). The anesthetic was administered through a single puncture on each side at the prostate-vesicular junction using a 22-gauge needle. All patients filled in a ten visual analogue pain score scale (VAS) from 0 = no discomfort to 10 = severe pain, for the assessment of pain experienced during biopsy. The two groups were homogeneous concerning the anthropometrical data. The mean pain score with lidocaine was 1.4 +/- 1.02 (CI 95% = 1.53 to 3.57) and with mepivacaine was 1.3 +/- 1.06 (CI 95% = 2.66 +/- 4.84) with no statistical significant difference between groups (p = 0.43). No general or local adverse effects were observed between the anaesthetics. The use of a low volume (2.5 ml on each side) and high concentration (2%) of local anesthetics (lidocaine/mepivacaine) almost completely suppresses pain and discomfort associated with prostate biopsy. The anatomy of neurovascular bundle regions appears favourable to the administration of small amounts of anesthetic.
authors.affiliation: Division of Urology, G. Mazzini Hospital, Teramo, Department of Surgery, L'Aquila University Medical School, L'Aquila, Italy. oreste.martella@virgilio.it
authors.forename: Oreste
authors.initials: O
authors.lastname: Martella
authors.forename: Giuseppe Paradiso
authors.initials: GP
authors.lastname: Galatioto
authors.forename: Gianna
authors.initials: G
authors.lastname: Pace
authors.forename: Luca
authors.initials: L
authors.lastname: Bergamasco
authors.forename: Guevar
authors.initials: G
authors.lastname: Maselli
authors.forename: Carlo
authors.initials: C
authors.lastname: Vicentini
mesh_terms: D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D001707:Biopsy, Needle; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008619:Mepivacaine / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D017060:Patient Satisfaction; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D018084:Ultrasonography, Interventional
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine; D008619:Mepivacaine