Periprostatic Nerve Block vs. Intravenous Ibuprofen for Pain Management During Transrectal Prostate Biopsy Procedures: A Prospective Comparative Study.

AIM: This study aimed both to compare the efficacy of intravenous (IV) ibuprofen with periprostatic nerve block (PPNB) in pain control during prostate biopsy procedures and to investigate factors influencing pain scores.

METHODS

A total of 128 patients were prospectively enrolled between June and December 2023 and randomized into two groups: IV ibuprofen was Group 1 (n = 64) and PPNB was Group 2 (n = 64). Pain levels were assessed using a Visual Analog Scale (VAS) at various stages of the procedure. Demographic and clinical data, including age, prostate specific antigen (PSA) levels, prostate volume, body mass index (BMI), histopathology results, and Prostate Imaging-Reporting and Data System (PI-RADS) scores, were recorded and correlated among themselves.

RESULTS

The mean ages (64.68 ± 5.87 vs 63.33 ± 7.26 years), and median PSA level was [13.00 (8.04-41.68) ng/mL vs 10.00 (6.73-23.80) ng/mL] of Group 1 and 2 were as indicated, (p = 0.267 and p = 0.053, respectively). There were no statistically significant differences between the two groups in terms of prostate volume, BMI, PI-RADS score, and benign-malignant pathology on biopsy (p > 0.05). The median VAS scores estimated during insertion of rectal probe [4 (2-5) vs 2 (0-3)], prostate biopsy needle [3 (2-4) vs 0 (0-1)], and overall median VAS scores [4 (3-4) vs 1 (0-2)] were lower in Group 2 than Group 1 (p < 0.001 for all stages). Correlation analyses revealed that PSA levels, and malignant pathology influenced the pain scores in Group 1 (r = 0.230, p = 0.024; r = 0.268, p = 0.032, respectively). Regression analysis demonstrated that PSA levels and malignant pathology affected the overall VAS scores in Group 1 (p = 0.024 and p = 0.019, respectively).

CONCLUSIONS

IV ibuprofen demonstrates promise as an easily applicable analgesic method for prostate biopsy, particularly for patients who are unwilling or unable to undergo PPNB. This study underscores the need for large-scale investigations to validate these findings.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov with identifier (NCT06737939).