A randomized controlled comparison between periprostatic nerve block and pelvic plexus block at the base and apex of 14-core prostate biopsies

  • Sung Jin Kim
  • Jongpill Lee
  • Dong Hyeon An
  • Chang-Hoo Park
  • Ju Hyun Lim
  • Han Gwun Kim
  • Jong Yeon ParkEmail author
Original Article



To compare the pain control efficacies of the pelvic plexus block (PPB), periprostatic nerve block (PNB), and controls during a 14-core basal and apical core prostate biopsy.


This randomized controlled study, performed between January 2015 and January 2016, included patients with an abnormal serum prostate-specific antigen (PSA > 3 ng/mL) level or a palpable nodule on digital rectal examination. The enrolled patients were randomized into three groups: Group 1, intrarectal local anesthesia (IRLA, 10 mL of 2% lidocaine jelly) and PPB with 3.0 mL of 2% lidocaine injected at the bilateral pelvic plexus; Group 2, IRLA and PNB with 3.0 mL of 2% lidocaine injected at both periprostatic nerves; and Group 3, only IRLA. Patients answered the visual analog scale (VAS) questionnaire at 6 time points.


This study consisted of 163 patients (Group 1 = 55, Group 2 = 55, and Group 3 = 53). Pain at the apical biopsy location was less in Groups 1 and 2 than in Group 3 (p < 0.001, p < 0.001) and between the two local anesthetic groups (PNB + IRLA vs PPB + IRLA). Group 2 patients reported less pain than Group 1 patients (p = 0.022). Pain during the basal core biopsy was significantly less in Groups 1 and 2 than in Group 3 (p = 0.002, p < 0.001), but there were no significant differences in pain control between the two methods (PNB + IRLA vs PPB + IRLA, p = 0.054) during basal core biopsy.


PNB + IRLA is an effective local anesthetic method for reducing pain when performing apical biopsies compared with PPB + IRLA or IRLA alone.


Pelvic plexus Prostate Biopsy Pain 


Author contribution

SJK: data management, data analysis, manuscript writing/editing. JL: data collection, data analysis. DHA: data collection data analysis. CP: data analysis. JHL: project development. HGK: manuscript writing/editing. JYP: project development, manuscript editing.


This work was supported by Gangneung Asan Hospital Medical Institute and was funded by the Asan Foundation (2014-009).

Compliance with ethical standards

Conflict of interest

The authors declare that there are no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Supplementary material

345_2019_2722_MOESM1_ESM.docx (477 kb)
Supplementary material 1 (DOCX 477 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of UrologyGangneung Asan Hospital, University of Ulsan College of MedicineGangneungRepublic of Korea
  2. 2.Department of UrologyAsan Medical Center, University of Ulsan College of MedicineSeoulRepublic of Korea

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