Comparison of Pelvic Plexus Blockade to other Conventional Techniques of Analgesia in Transrectal Ultrasound Guided Prostate Biopsy

Objectives: To compare the degree of pain, efficacy and safety of pelvic plexus block to other conventional techniques of analgesia in 12 core transrectal ultrasound guided biopsy of prostate. Materials and Methods: The study included 160 consecutive cases of prostate biopsy, prospectively randomized into four groups of 40 each –Men in group 1 (control arm) received lignocaine gel (2%) only; Group 2 received lignocaine gel with basal periprostatic nerve block (BPNB) with 2% lignocaine; Group 3 received lignocaine gel (2%) with apical periprostatic block (APNB) with 2% lignocaine and Group 4 received lignocaine gel with pelvic plexus block. Pain was recorded on a 10 point visual analogue scale by a nurse. Results: Patients in pelvic plexus block group had lowest pain score (1.25±0.43) while lignocaine injection than BPNB (1.53±0.45) and APNB (1.58±0.50, P value = 0.008). The mean pain score among 4 groups while taking the biopsy cores were 4.85, 2.67, 2.48 and 1.95, respectively. Patients who received pelvic plexus block experienced least pain than BPNB and APNB groups (p value 0.001 and 0.002, respectively). Perineal pain persisted longer in pelvic plexus block group than apical and periprostatic groups. Duration of dysuria was less in pelvic plexus nerve block group. Hematuria and rectal bleed complications were comparable in all groups. Conclusion: Prostate biopsy should be performed with either periprostatic nerve block (basal or apical) or pelvic plexus block under Doppler ultrasonography guidance. Pelvic plexus block provides superior analgesia to basal and apical periprostatic block.