Combination of lidocaine suppository and periprostatic nerve block during transrectal prostate biopsy: A prospective randomized trial - Abstract

OBJECTIVE: To assess the most effective local analgesia during transrectal ultrasound-guided prostate biopsy.

METHODS: A total of 123 consecutive patients undergoing transrectal ultrasound-guided prostate biopsy for elevated prostate-specific antigen levels and/or a suspicious digital rectal examination were randomized to three groups. Patients received a 60-mg lidocaine suppository (group 1, n = 41), a periprostatic nerve block (10-mL injection of lidocaine hydrochloride; group 2, n = 41) or a combination of both (group 3, n = 41) before a 10-core transrectal ultrasound-guided biopsy. A total of 80.5% (n = 99) of the patients underwent their first biopsy, 27.1% (n = 22) their second and 2.4% (n = 2) the third. Pain was evaluated on a 10-point visual analog scale for each step of the procedure.

RESULTS: Prostate-specific antigen values ranged from 0.39 to 90.1 (mean [SD] 8.76 ng/mL (11.08 ng/mL)). Comparison of the median visual analog scale scores between groups 1 and 2 showed a significant difference (P = 0.004). The differences in the outcomes between groups 1 and 3 (P = 0.001), and groups 2 and 3 (P = 0.001) were also significant. Patients of group 3 had the best output corresponding to the pain sensations and therefore the lowest visual analog scale scores.

CONCLUSION: The combination of lidocaine suppository and periprostatic lidocaine infiltration is more effective for pain control than either lidocaine suppository or periprostatic lidocaine infiltration alone in patients undergoing transrectal ultrasound-guided prostate biopsy.

Written by:
Lunacek A, Mrstik C, Simon J, Frauscher F, Schwentner C, Radmayr C, Horninger W, Plas E.   Are you the author?
Department of Urology, Hanusch Krankenhaus, Vienna, Austria.

Reference: Int J Urol. 2014 Jun 26. Epub ahead of print.
doi: 10.1111/iju.12542


PubMed Abstract
PMID: 24974854

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