Comparative Study on the Impact of Traditional Basal Versus Combined Apical and Basal Periprostatic Nerve Block on Pain During for Transrectal Ultrasound Guided Biopsy of the Prostate

Comparative Study on the Impact of Traditional Basal Versus Combined Apical and Basal Periprostatic Nerve Block on Pain During for Transrectal Ultrasound Guided Biopsy of the Prostate
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Title:Comparative Study on the Impact of Traditional Basal Versus Combined Apical and Basal Periprostatic Nerve Block on Pain During for Transrectal Ultrasound Guided Biopsy of the Prostate
Author/Abstract:
Mellmont L. Ocampo, MD; Jo-Anne D. Ponce, MD and Dennis G. Lusaya, MD

Section of Urology, Department of Surgery, University of Santo Tomas Hospital

Objective: To determine the effectiveness of the combined apical and basal periprostatic block in comparison to the traditional basal periprostatic block in reducing the pain associated with transrectal ultrasound guided biopsy of the prostate. Materials and Methods: This is a comparative clinical study of patients that underwent transrectal ultrasound guided biopsy of the prostate from June 2006 to September 2007 at the University of Santo Tomas Hospital. Group 1 with 40 subjects who received combined apical and basal periprostatic block was compared with Group 2 with 35 historical subjects who received basal block alone. A visual analog scale (VAS) was used to assess the pain scores. The t-test was performed on all epidemiologic data. The differences in pain scores were analyzed using multiple analysis of variance (MANOVA). P <0.05 was considered the probability level to reflect significant differences. Complications were also noted. Results: The t-test was performed on all epidemiologic characteristics and showed no statistical difference between the two groups: age (p=0.73), PSA level (p=0.09), prostate volume (p=0.48). The difference in VAS scores between the two treatment groups (Group1= 0.8 vs. Group 2= 2.0), considering other variables as age, prostate volume and PSA levels, using MANOVA with Wilks' Lambda value of 0.686257, is statistically significant (p=0.000023). Complications observed were minimal. Conclusion: Combining apical and basal periprostatic nerve block for TRUS guided biopsy of the prostate provided better pain relief compared to basal periprostatic nerve block alone. Due to its effectivity and minimal associated complications, this method is recommended to further improve patient's acceptability, tolerance and comfort during the procedure.

Key words: periprostatic nerve block, prostate biopsy, pain scores
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