ABSTRACT
Objective: The aim of our study was to compare the efficacy and complications of periprostatic lignocaine injection with transrectal instillation of lignocaine gel or placebo for the relief of pain associated with transrectat ultrasound [TRUS] guided needle biopsy of the prostate
Patients and Methods: Between March 2003 and January 2004, 210 patients were prospectively randomized to recieve periprostatic injection of 10m12% lignocaine [Group 1, n = 83], intrarectal instilation of 15ml 2% lignocaine gel [Group 2, n = 64] or intrarectal instilation of l0mI water-souluble gel [placebo] [Group 3, n = 63]. The degree of pain experienced during and 15 minutes after completion of the biopsy was recorded by the patient himself, using a visual pain score [VPS] with a scale from 0 [no pain] to 10 [the most severe pain possible]. Statistical evaluation was performed using analysis of variance [ANOVA] with post-hoc analyses using the Bonferroni correction
Results: There were no statistically significant differences between the groups with regard to the mean number of biopsy cores, serum PSA or prostate volume. The mean VPS during biopsy was 2.02, 3.05 and 5.16 in Groups 1, 2 and 3, respectively [all differences statistically significant]. The mean VPS 15 minutes after biopsy was significantly lower in Group 1 [1.43] compared to Group 3 [3.28, p<0.001] but not Group 2 [2.17, p = 0.086], and it was significantly lower in Group 2 compared to Group 3 [p=0.006]. With regard to complications, there were no statistically significant differences between the groups, except for rectal bleeding which occurred more frequently in Group 3 [23.2%] than in Groups 1 [7.9%, p 0.033] and 2 [11.5%, p=0.l86]. There was no significant difference with regard to the percentage of patients who would be willing to return for a repeat biopsy [95.7%, 87% and 91.7% in Groups 1, 2 and 3 respectively]
Conclusions: For pain relief during and after TRUS guided needle biopsy of the prostate, periprostatic injection of 10 ml 2% lignocaine was significantly more effective than intrarectal instillation of 15 ml 2% lignocaine gel, which in turn was more effective than intrarectal lubricant [placebo] gel. The incidence of complications was not increased after periprostatic lignocaine injection. Although the greater pain experienced by the patient during biopsy without anesthesia did not result in a significantly greater unwillingness to return for repeat biopsy, considerations of human compassion dictate that all patients undergoing TRUS guided prostate biopsy should routinely be offered local anesthesia