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Prospective comparison of the efficacy of caudal versus periprostatic nerve block, both with intrarectal local anesthesia, during transrectal ultrasonography-guided prostatic needle biopsy

Abstract Objective: The aim of this study was to compare the effectiveness of caudal block (CB) versus periprostatic nerve block (PPNB), both with intrarectal local anesthesia (IRLA), in reducing pain during transrectal ultrasonography (TRUS)-guided prostatic biopsy. Materials and methods: This study included 532 patients: 266 patients received CB with IRLA and 266 patients PPNB with IRLA. A visual analogue scale (VAS) was applied to prospectively evaluate pain (1) at induction of anesthesia, (2) at insertion of the TRUS probe, (3) at needle penetration to the prostate, and (4) throughout the biopsy procedure. Pain scores were compared to evaluate differences between groups. The secondary endpoint of serious complication rate was also evaluated. As a subanalysis, the pain scores were compared in patients with high body mass index (BMI ≥25 kg/m²). Results: Overall, the pain score in the PPNB group was significantly lower than in the CB group at induction of anesthesia (mean ± SD: 2.0 ± 1.9 vs 2.9 ± 2.1, p = .0001) but higher at insertion of the TRUS probe (2.7 ± 2.5 vs 1.9 ± 1.7, p = .009). The pain score did not differ significantly between groups at needle penetration or throughout the biopsy. Univariate analyses indicated no significant association between VAS scores and patient demographics. Overall rates of serious complications did not differ between the two groups (5.6% vs 5.3%, p = .85). In patients with high BMI, the pain score was significantly lower in the PPNB group than in the CB group throughout the procedure (2.5 ± 2.0 vs 3.5 ± 2.5, p = .03). Conclusions: Both procedures were equally effective in reducing pain, and the incidence of serious complications was similar. PPNB with IRLA may be more applicable than CB with IRLA in obese patients.