Doppler Ultrasonography-guided Pelvic Plexus Block before Systematic Needle Biopsy of the Prostate: A Prospective Randomized Study

Abstract

OBJECTIVES To report a new method to block pelvic plexus and compare its efficacy with widely used periprostatic nerve block (PPNB) for transrectal ultrasonography-guided prostate biopsy. Pelvic plexuses were localized with the aid of color Doppler Ultrasonography to create the pelvic block. METHODS This study was a single-center, prospective randomized trial. A total of 80 patients were recruited in 2 groups, with 40 patients in each. In group 1 (PPNB group), 2 mL of 2% lidocaine was injected between the prostate base and seminal vesicle on each side, using ultrasonic guidance. In group 2 (pelvic plexus block group), 2 mL of 2% lidocaine was injected into the region of the pelvic plexus lateral to the tip of vesicula seminalis on each side, using ultrasonic guidance. Color Doppler ultrasonography was used to identify injection sites. Patients were given an 11-point visual analog scale (VAS) to evaluate the level of pain encountered during probe insertion, injection of local anesthetic, and biopsy procedure. RESULTS In both groups, probe insertion was the least painful stage. With regard to local anesthetic injection, VAS pain score was significantly lower in group 2 (2.05 vs 3.12, P = .0007). Sampling the prostate was the most painful stage in both groups and group 2 had significantly lower biopsy VAS pain scores (2.7 vs 4.97, P < .0001). There were no major complications. CONCLUSIONS Administration of lidocaine in the area of the pelvic plexus under Doppler ultrasonographic guidance provides superior analgesia to PPNB, with limited morbidity during transrectal ultrasonography-guided biopsy of the prostate. UROLOGY 74: 267-272, 2009. (C) 2009 Elsevier Inc.