Pelvic plexus block is more effective than periprostatic nerve block for pain control during office transrectal ultrasound guided prostate biopsy: A single center, prospective, randomized, double arm study

Purpose: We compared intrarectal local anesthesia plus pelvic plexus block vs intrarectal local anesthesia plus periprostatic nerve block during transrectal ultrasound guided prostate biopsy. Materials and Methods: Patients were randomized 1:1 by a computer generated schedule into group 1 - 90 who received intrarectal local anesthesia (lidocaine 1.5%-nifedipine 0.3% cream) plus pelvic plexus block (2.5 ml lidocaine 1% plus naropine 0.75% injected on each side into the pelvic neurovascular plexus lateral to the seminal vesicle tip) and group 2 - 90 who received intrarectal local anesthesia plus periprostatic nerve block (2.5 ml of the same mixture injected on each side into the neurovascular bundles at the prostate-bladder-seminal vesicle angle) before transrectal ultrasound guided prostate biopsy. After the procedure patients were instructed to rate the level of pain/discomfort from 0 to 10 on the visual analog scale at certain time points, including during the introduction and presence of the probe in the rectum, during pelvic plexus block or periprostatic nerve block, during biopsy and 30 minutes after biopsy. Results: The 2 groups were similar in age, serum prostate specific antigen and total prostate volume. There was no difference in pain perception during probe introduction and pelvic plexus or periprostatic nerve block. Pain during prostate biopsy was significantly lower in group 1 than in group 2 (p <0.001). The same trend was recorded for pain perception 30 minutes after biopsy (p = 0.001). There were no major complications. Conclusions: Pelvic plexus block under Doppler ultrasound guidance provides better analgesia than periprostatic nerve block during office based transrectal ultrasound guided prostate biopsy.