Nerve Block or Gel? Comparing Analgesia Techniques for Enhancing Comfort During Trans-Rectal Ultrasound-Guided Prostate Biopsy
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Abstract
Background: Transrectal ultrasound-guided prostate biopsy (TRUS PBx) is a widely used method for diagnosing prostate cancer. Ensuring effective pain control during this procedure is essential for patient comfort and compliance. Apical periprostatic nerve block (PNB) and intrarectal topical anaesthesia (ITA) are two commonly employed anaesthetic techniques. This study aimed to compare the analgesic effectiveness of apical PNB versus ITA during TRUS-guided prostate biopsy. Methods: In this prospective, randomised comparative trial, participants were allocated into two groups. Group 1 was administered 10ml of 2% lignocaine through apical periprostatic infiltration, whereas Group 2 received 10ml of xylocaine gel via intrarectal application. Pain assessment was performed using the Wong-Baker FACES Pain Rating Scale (WBFPRS) during probe insertion, biopsy, and post-procedure. Baseline characteristics were comparable between groups. Results: Both anaesthetic techniques relieved pain; however, Group 1 consistently exhibited lower pain scores. During biopsy, Group 1 reported significantly less pain than Group 2 (p = 0.001), and this difference remained significant 30 minutes post-procedure (p = 0.001). Most patients in Group 1 recorded pain scores of 0 or 2 post-biopsy, indicating minimal discomfort. On Day 3 follow-up, no significant differences were observed in post-biopsy complications, although there was a non-significant trend toward increased haematuria in the ITA group (p = 0.304). Conclusion: Apical PNB is more effective than ITA for pain control during TRUS PBx and does not influence delayed post-procedural outcomes. These results support the efficacy of apical periprostatic nerve block (PNB) in improving patient comfort during prostate biopsy, without compromising procedural safety.
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Copyright (c) 2025 Dr Dron Sharma, Dr Puvvada Sandeep, Dr Prasad Mylarappa, Dr Manasa T
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