Cancer - Prostate(구연) (NP-039) 전립선 경직 초음파 유도 생검의 가장 효과적인 국소 마취는 무엇인가? 47 개의 무작위 임상 시험에 대한 체계적인 검토 및 네트워크 메타 분석 ¹연세대학교 의과대학 강남세브란스병원 비뇨의학과 ²연세대학교 의과대학 세브란스병원 비뇨의학과 ³연세대학교 원주의과대학 원주세브란스기독병원 비뇨의학과 김도경¹, 이주용², 정재흥³, 하윤수¹, 구교철¹, 이광석¹, 정병하¹, 조강수¹ Background: To compare the effectiveness of various local anesthetic methods for controlling prostate biopsy (PBx) related pain using network meta-analysis. Methods: Literature searches were performed on PubMed/Medline, Embase, and Cochrane Library up to March 2018. Forty-seven randomized controlled trials, in which the effectiveness of PBx-related pain was investigated using a visual analogue scale after various local anesthetic methods, were included. The local anesthetic methods included intraprostatic local anesthesia (IPLA), intrarectal local anesthesia (IRLA), intravenous sedation (IVS), periprostatic nerve block (PNB), pelvic plexus block (PPB), and spinal anesthesia (SPA). Results: Eight pairwise meta-analyses and network meta-analyses with 21 comparisons were performed. All modalities, except single use of IPLA and IRLA, were more effective than placebo. Our results demonstrate that PNB+IVS (rank 1) and SPA (rank 2) were the most effective methods for pain control. The followings are in order of PPB+IRLA, PNB+IPLA, PPB, PNB+IRLA, IVS, and PNB. Conclusions: The most effective way to alleviate PBx-related pain appears to be PNB+IVS and SPA. However, a potential increase in medical cost and additional risk of morbidities should be considered. In the current outpatient setting, PPB+IRLA, PNB+IPLA, PPB, PNB+IRLA, and PNB methods are potentially more acceptable options. keywords : local anesthesia, prostate biopsy, network meta-analysis