Korean J Urol.  2004 Mar;45(3):236-239.

A Prospective Randomized Study Comparing Effectiveness of Local Anesthesia Techniques in Patients undergoing Transrectal Ultrasound-guided Prostate Biopsy

• Song S
• Ji YH
• Lee SB
• You DS
• Kim JK
• Park JY
• Ahn HJ
• Kim CS

Abstract

PURPOSE: This study was designed to compare the effectiveness of intrarectal lidocaine gel versus periprostatic lidocaine injection during TRUS-guided biopsies.
MATERIALS AND METHODS
From April 2003 to September 2003, 90 men undergoing a transrectal prostate biopsy were randomized into three groups. In group 1, 30 patients intrarectally received 20ml of 2% lidocaine gel; and group 2, 30 patients received 5ml(2.5ml per side) of 2% lidocaine solution injected along each side of the prostate, near the junction of the seminal vesicle and the base of the prostate(along the neurovascular bundles); in group 3, 30 patients received 5ml(2.5ml per side) of normal saline injected along the neurovascular bundles. The pain level after the biopsy was assessed using a 10-point linear visual analog pain scale(VAS). A statistical analysis was performed using the Wilcoxon Rank Sum test, and the results compared.
RESULTS
Patient who received lidocaine solution injections along the neurovascular bundles (Group 2) had significantly lower VAS scores compared to the control group(mean score 3.56+/-2.13 versus 5.83+/-1.94, p<0.0001), but patients who received intrarectal lidocaine gel did not (mean score 5.46+/-2.70 versus 5.83+/-1.94, p=0.671). Gross hematuria, rectal bleeding and hemospermia occurred in 36(40.0%), 6(6.7%) and 5(5.6%) subjects, respectively. One patient had a vasovagal syncope. No patient reported febrile UTI or urinary retention.
CONCLUSIONS
Bilateral nerve blockade with local anesthetic is a safe technique that significantly reduces pain during a prostate biopsy. However, in this study, intrarectal lidocaine injection did not reduce the pain compared to the control group during the prostate biopsy.

Keyword

Prostate; Biopsy; Pain; Local anesthetics

MeSH Terms

Anesthesia, Local*
Anesthetics, Local
Biopsy*
Hematuria
Hemorrhage
Hemospermia
Humans
Lidocaine
Male
Nerve Block
Prospective Studies*
Prostate*
Seminal Vesicles
Syncope, Vasovagal
Urinary Retention
Anesthetics, Local
Lidocaine