Investig Clin Urol.  2025 Mar;66(2):130-136. 10.4111/icu.20240312.

Combination of intrarectal heated lidocaine gel and periprostatic nerve block for pain control during transrectal ultrasound-guided prostate biopsy: A prospective randomized trial

• Kim JI
• Sohn DW
• Park BH

• KMID: 2565585
• DOI: http://doi.org/10.4111/icu.20240312

Abstract

Purpose
To investigate the role of combined periprostatic nerve block (PNB) and intrarectal local anesthesia with heated lidocaine gel (ILAHL) in reducing pain during transrectal ultrasound (TRUS)-guided prostate biopsy, compared with PNB alone.
Materials and Methods
We performed a prospective randomized trial with 140 participants who underwent systematic TRUS-guid ed, 12-core prostate biopsy from July 2021 to June 2022. These participants were divided into two groups. Before prostate biopsy, group 1 (n=70) received PNB and group 2 (n=70) received PNB combined intrarectal local anesthesia with 20 mL of heated (40ºC) 2% lidocaine gel. The primary outcome was pain score on a 0–10 visual analogue scale (VAS) at four time points (VAS A: during local anesthesia procedure, VAS B: during probe insertion, VAS C: during biopsy procedure, VAS D: 30 minutes after biopsy). The secondary outcome included adverse events during and after the procedure.
Results
Mean pain scores were significantly lower in group 2 than in group 1 at VAS A (2.53 vs. 1.60, p=0.001) and VAS B (2.47 vs. 1.49, p<0.001). The mean VAS C pain score in group 2 was significantly less than in group 1 (3.07 vs. 2.20, p=0.001), while there was no significant difference in the mean VAS D pain score between two groups (1.06 vs. 0.89, p=0.318). There were no significant differences in the occurrence of complications in both groups.
Conclusions
The combination of PNB and ILAHL provides more effective pain control than PNB alone without increase of complication rates in patients undergoing TRUS-guided prostate biopsy.

Keyword

Anesthesia, local; Biopsy; Pain; Prostate