Comparison of analgesic techniques in MRI-guided in-bore prostate biopsy
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To evaluate different analgesic techniques in MRI-guided in-bore prostate biopsy (IB-GB) regarding the influence on patient procedural experience of pain.
Two hundred fifty-two consecutive patients who had received an IB-GB either with intrarectal instillation of 2% lidocaine gel (n = 126, group A) or with periprostatic nerve block (PPNB) with 2% mepivacaine (n = 126, group B) were retrospectively included in this study. Pain scores were measured on a visual analog scale, the operating room time (ORT) was recorded for each biopsy and correlations between the parameters were analysed.
Pain scores for IB-GB were slightly lower in group B compared with group A (2.0 ± 1.9; 2.4 ± 1.7; p = 0.02). In group A, significantly more targeted biopsy cores were acquired (group B: 5.2 ± 1.1; group A: 5.6 ± 0.8; p < 0.01). ORT was comparable and not significantly different in both groups. There was only a weak correlation between pain scores and ORT in group B (rS = 0.22; p = 0.01), but no correlation between pain scores and the number of biopsy cores or the prostate volume.
Pain levels are generally low for MRI-guided in-bore biopsy using either PPNB or intrarectal instillation of lidocaine gel. A statistically significant, slightly lower pain score was documented for PPNB and might be preferred when the focus is analgesia. On the other hand, due to the minor difference and easier administration, intrarectal gel instillation seems to be a reasonable practice for standard analgesia for MRI-guided in-bore biopsy.
• Pain levels were low for MRI-guided in-bore biopsy using either PPNB or intrarectal instillation of lidocaine gel as analgesic method.
• PPNB prior to IB-GB resulted in a slightly lower pain score but required a higher effort.
• Intrarectal gel anaesthesia seems to be a reasonable practice for standard analgesia for IB-GB in an outpatient setting.
KeywordsProstate cancer Analgesics Image-guided biopsy Magnetic resonance–guided interventional procedures
Cognitive fusion–guided biopsy
European Association of Urology
MRI/US fusion–guided prostate biopsy
MRI-guided in-bore prostate biopsy
Multiparametric magnetic resonance imaging
Operating room time
Periprostatic nerve block
Spearman correlation coefficient
The authors state that this work has not received any funding.
Compliance with ethical standards
The scientific guarantor of this publication is Lars Schimmöller.
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Statistics and biometry
One of the authors has significant statistical expertise.
No complex statistical methods were necessary for this paper.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional Review Board approval was obtained.
Study subjects or cohorts overlap
Some study subjects or cohorts have been previously reported:
Some patients in study group A were previously enrolled in a prospective randomised trial assessing the diagnostic efficacy of IB-GB and FUS-GB (ClinicalTrials.gov identifier: NCT02220517; Arsov C, Rabenalt R, Blondin D, et al (2015) Eur Urol).
Patients in study group B were previously enrolled in a prospective randomised trial assessing the diagnostic efficacy of IB-GB in comparison with TRUS-GB in biopsy-naïve men with elevated PSA (ClinicalTrials.gov identifier: NCT01553838; Quentin M, Blondin D, Arsov C, et al (2014) J Urol).
• diagnostic or prognostic study
• performed at one institution
- 3.Arsov C, Rabenalt R, Blondin D et al (2015) Prospective randomized trial comparing magnetic resonance imaging (MRI)-guided in-bore biopsy to MRI-ultrasound fusion and transrectal ultrasound-guided prostate biopsy in patients with prior negative biopsies. Eur Urol 68:713–720. https://doi.org/10.1016/j.eururo.2015.06.008 CrossRefPubMedGoogle Scholar
- 4.Quentin M, Blondin D, Arsov C et al (2014) Prospective evaluation of magnetic resonance imaging guided in-bore prostate biopsy versus systematic transrectal ultrasound guided prostate biopsy in biopsy naïve men with elevated prostate specific antigen. J Urol 192:1374–1379. https://doi.org/10.1016/j.juro.2014.05.090 CrossRefPubMedGoogle Scholar
- 5.Wegelin O, van Melick HHE, Hooft L et al (2017) Comparing three different techniques for magnetic resonance imaging-targeted prostate biopsies: a systematic review of in-bore versus magnetic resonance imaging-transrectal ultrasound fusion versus cognitive registration. Is there a preferred technique? Eur Urol 71:517–531. https://doi.org/10.1016/j.eururo.2016.07.041 CrossRefPubMedGoogle Scholar
- 10.Adamakis I, Mitropoulos D, Haritopoulos K et al (2004) Pain during transrectal ultrasonography guided prostate biopsy: a randomized prospective trial comparing periprostatic infiltration with lidocaine with the intrarectal instillation of lidocaine-prilocain cream. World J Urol 22:281–284. https://doi.org/10.1007/s00345-003-0386-4 CrossRefPubMedGoogle Scholar
- 11.Rodriguez A, Kyriakou G, Leray E et al (2003) Prospective study comparing two methods of anaesthesia for prostate biopsies: apex periprostatic nerve block versus intrarectal lidocaine gel: review of the literature. Eur Urol 44:195–200. https://doi.org/10.1016/S0302-2838(03)00188-X CrossRefPubMedGoogle Scholar
- 15.Pokorny M, Kua B, Esler R et al (2018) MRI-guided in-bore biopsy for prostate cancer: what does the evidence say? A case series of 554 patients and a review of the current literature. World J Urol 1–17. https://doi.org/10.1007/s00345-018-2497-y