BACKGROUND To determine the efficacy and safety of a periprostatic nerve block combined with perineum subcutaneous anaesthesia and intrarectal lidocaine gel for transrectal ultrasound-guided transperineal prostate biopsy (TPBx) through a prospective randomised controlled trial. METHODS In total, 216 patients from May 2018 to November 2018 were randomly assigned to the experimental group and the control group at a ratio of 1:1. The experimental group received a periprostatic nerve block combined with subcutaneous perineal anaesthesia and intrarectal lidocaine gel. The control group received total intravenous anaesthesia. A visual analogue scale (VAS) score (0-10) was used to evaluate pain at different stages. The operative time, duration of hospitalisation, intraoperative vital signs, perioperative complications and clinicopathological features were recorded. RESULTS The overall detection rate of prostate cancer was 40.74%, and the median Gleason score was 8 for all patients diagnosed with prostate cancer. No significant differences in terms of detection rates, Gleason scores and ISUP/WHO Grade Groups were found between the two groups (P > 0.05). The experimental group had no pain or just met the criteria for mild pain during the biopsy, which was significantly alleviated after the biopsy, and had a shorter operation time compared with that of the control group (P < 0.05). Compared with the control group, the experimental group had more stable haemodynamics and respiratory status and fewer surgical complications (P < 0.05). CONCLUSIONS In multiple aspects, a periprostatic nerve block combined with subcutaneous perineal anaesthesia and intrarectal lidocaine gel is a safer and more efficient approach to local anaesthesia for TPBx that can almost replace total intravenous anaesthesia and is worthwhile applying in the clinical setting.

中文翻译：

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前列腺周围神经阻滞联合会阴皮下麻醉和直肠内利多卡因凝胶在经直肠超声引导的会阴前列腺活检中的疗效和安全性：一项前瞻性随机对照试验。

背景技术通过一项前瞻性随机对照试验来确定前列腺周围神经阻滞结合会阴皮下麻醉和直肠内利多卡因凝胶对经直肠超声引导的会阴前列腺活检（TPBx）的疗效和安全性。方法将2018年5月至2018年11月的216例患者按1：1比例随机分为实验组和对照组。实验组接受前列腺周围神经阻滞联合皮下会阴麻醉和直肠内利多卡因凝胶治疗。对照组接受全静脉麻醉。视觉模拟量表（VAS）评分（0-10）用于评估不同阶段的疼痛。手术时间，住院时间，术中生命体征，记录围手术期并发症和临床病理特征。结果所有诊断为前列腺癌的患者中，前列腺癌的总检出率为40.74％，中位格里森评分为8。两组之间在检出率，格里森评分和ISUP / WHO等级组方面均无显着差异（P> 0.05）。实验组无疼痛或仅符合活检中轻度疼痛的标准，活检后疼痛明显减轻，且与对照组相比手术时间更短（P <0.05）。与对照组相比，实验组血液动力学和呼吸状况更稳定，手术并发症更少（P <0.05）。结论在多个方面，