[Local anesthesia in transrectal ultrasound-guided prostate biopsy: apical periprostatic nerve block versus endorectal lidocaine gel A randomized controlled trial about 100 patients]

ABSTRACT

Intrarectal lidocaine application and apical periprostatic nerve block are a safe technique that significantly reduces pain during transrectal prostate biopsy. We compare prospectively the effectiveness of intrarectal lidocaine gel versus periprostatic lidocaine injection during transrectal ultrasound -guided prostate biopsy. From June 2005 to February 2006, 100 consecutive patients underwent prostatic biopsies. Patients were randomized to receive 10 cc of 2% lidocaine gel in endorectally [Group I], 10 cc of 1% lidocaine solution injected into the prostate apex to induce bilateral periprostatic nerve block [Group II], or intrarectal 10 cc of ultrasound gel as placebo [Groupe III]. Pain was evaluated by a 10- point linear visual analogue pain scale [VAS], and a 5-point digital visual scale [DVS]. The side effects of the drugs and complications were also evaluated. The three groups counted respectively 33, 33 and 34 patients and were statically comparable as the age, prostate volume, PS A level and the number of biopsies. The mean pain score on the VAS was respectively 4,1; 4,6 and 3,5 for the three groups. The DVS score was 2,5; 2,8 and 2,15 [p < 0.001]. Pain scores were significantly lower in Group 3 and equivalent between Groups 1 and 2. There is no difference in complication rate between the three groups. Compared to intrarectal lidocaine application, apical periprostatic nerve block is a safe technique that significantly reduces pain during transrectal prostate biopsy, with no increase in the complication rate