A prospective randomized trial using a combination of lidocaine suppository and periprostatic nerve block during transrectal prostate biopsy, "Beyond the Abstract," by Andreas Lunacek, MD, et al.

BERKELEY, CA (UroToday.com) - The diagnostic modality of choice for detecting prostate cancer is transrectal ultrasound (TRUS)-guided biopsy. The number of prostate biopsies has increased in association with the rising incidence of prostate cancer worldwide, and early diagnosis may decrease cancer-related mortality. Because prostate biopsy is accompanied by anxiety and substantial pain, it is necessary to provide adequate analgesia. This study examined the efficacy of a combination of lidocaine suppository and periprostatic nerve block during 10-core TRUS biopsy and, as described below, the results were promising.

The study was conducted as a single-center, prospective, randomized, double-blind, three-arm, non-placebo controlled clinical trial. Because it is unacceptable to perform prostate biopsy without analgesia, it was decided to omit a placebo group. A total of 123 patients of European ethnicity with elevated prostate-specific antigen levels and/or suspicious digital rectal examination results, and without active prostatitis, were included. The patients were randomized into three groups. Group 1 (n=41) received a 60mg lidocaine suppository 20 minutes before the biopsy; Group 2 (n=41) received ultrasound-guided periprostatic infiltration of 10mL lidocaine hydrochloride (2%) 10 minutes before biopsy; and Group 3 (n=41) received a combination of both agents.

Pain and discomfort related to the intervention were measured using various instruments. After insertion of the ultrasound probe, the patients were asked to describe their condition as problem free, unpleasant, or painful. To quantify the pain level related to the biopsy itself, 10-point visual analog scale (VAS) was used.

The results indicate that use of the lidocaine suppository provided patients with greater comfort during insertion of the ultrasound probe as well as during the injection of lidocaine for periprostatic nerve block.

The analysis of the collected data clearly demonstrated that the patients in Group 3 had better pain control than those in either Group 1 or Group 2, and also had the lowest VAS scores. The combination of the lidocaine suppository with transrectal periprostatic lidocaine injection was more effective for pain control during TRUS-guided prostate biopsy than either of these agents administered alone. These results emphasize the advantage of the combination of these agents for pain control. Furthermore, because this pain management strategy is easy to handle, safe, and inexpensive, it may come to be regarded as the means of choice for analgesia during TRUS-guided prostate biopsy.

Written by:
Andreas Lunacek,1 Meyer Christine, Schorm Anna Christof Mrstik,1 Josef Simon,2 Ferdinand Frauscher,5 Christian Schwentner,3 Christian Radmayr,4 Wolfgang Horninger,4 and Eugen Plas1 as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.

Departments of 1Urology and 2Radiology, Hanusch Krankenhaus, Vienna, Austria; 3Department of Urology, Eberhard-Karls University, Tuebingen, Germany; and Departments of 4Urology and 5Radiology, Medical University Innsbruck, Innsbruck, Austria

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

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