[Ultrasound guided transrectal prostatic biopsy and pain. Prospective randomized study comparing lubricant gel, lidocaine gel, and anesthetic blockage of the neurovascular bundles with 1% lidocaine]. / Biopsia prostática transrectal ecodirigida y dolor. Estudio prospectivo aleatorizado comparando gel lubricante, gel con lidocaína y bloqueo anestésico de haces neurovasculares con lidocaína 1%.

OBJECTIVES: To quantify anxiety and immediate and late pain, efficacy of the common analgesic methods, and complications. METHODS: 117 patients were randomized to three groups: 1 (39): lubricant gel; 2 (38): intrarectal lidocaine gel; 3 (40): anesthetic blockage with 1% lidocaine. Complications and immediate and late pain were collected, these latter with a visual analogic scale. RESULTS: 70% of the patients were not much anxious. We did not find significant differences between the analgesia achieved in group 1 (4.37 +/- 2.41) and group 2 (4.22 +/- 2.46), but we found with group 3 (1.88 +/- 2.03). Mean pain score the afternoon after biopsy was lower in group 3 (2.08 +/- 2.28) than in groups 1 and 2 (4.06 +/- 2.80 and 2.42 +/- 2.03), without statistical significance. The patients did not show a difference in pain during the pass of the transrectal transducer, varying between 2.34 for group 3 and 3.38 for group 2. Grouped by sphincter tone we find differences (low 2.71 +/- 2.76, medium 3.23 +/- 2.38, high 4.99 +/- 2.22). Patients feeling very nervous before the test had a pain score of 4.98 +/- 2.57, significantly greater than the pain of those not feeling nervous (2.59 +/- 2.21). We did not find differences in complications between the three groups. CONCLUSIONS: The use of intrarectal lidocaine gel did not demonstrated being more effective in pain control in our series than the use of lubricant gel, but lidocaine injected into the apex and seminal vesicles was. Sphincter tone and pretest anxiety are the most determinants factors for pain.

Biopsia prostática transrectal ecodirigida y dolor. Estudio prospectivo aleatorizado comparando gel lubricante, gel lidocaína y bloqueo anestésico de haces neurovasculares con lidocaína 1% / Ultrasound guided transrectal prostatic biopsy and pain. Prospective randomized study comparing lubricant gel, lidocaine gel, and anesthetic blockage of the neurovascular bundles with 1% lidocaine

Objetivo: Cuantificar ansiedad y dolor inmediato y tardío producidos, efectividad de los métodos analgésicos comunes y complicaciones. Métodos: 117 pacientes fueron distribuidos aleatoriamente en tres grupos: 1 (39): lubricante gel, 2 (38): lidocaína en gel intrarrectal, 3 (40): bloqueo anestésico con lidocaína al 1%. Se recogieron las complicaciones y el dolor inmediatos y tardíos mediante una escala visual analógica. Resultados: 70% de pacientes estaban poco ansiosos. No encontramos diferencias significativas entre la analgesia conseguida en el grupo 1 (4.37±2.41) y 2 (4.22±2.46), pero sí con el 3 (1.88±2.03). La media de dolor la tarde tras la prueba fue menor en el grupo 3 (2.08 ± 2.28) que en 1 y 2 (4.06±2.80 y 2.42±2.03), pero sin significación estadística. Los pacientes no mostraron un dolor distinto al paso del transductor transrectal, oscilando entre 2.34 para el grupo 3 y 3.38 para el grupo 2. Agrupados según tono esfinteriano, sí encontramos diferencias (bajo 2.71±2.76, medio 3.23±2.38, alto 4.99±2.22). El dolor presentado por los pacientes que decían estar muy nerviosos pre-prueba fue de 4.98±2.57, significativamente mayor que el presentado por los que decían estar nada nerviosos (2.59±2.21). No encontramos diferencias en las complicaciones entre los tres grupos. Conclusiones: El empleo de gel intrarrectal de lidocaína no ha demostrado en nuestra serie ser más eficaz que el uso de lubricante para el control del dolor, pero sí la lidocaína inyectada en ápex y vesículas seminales. Tono esfinteriano y ansiedad preprueba son los factores más determinantes en el grado de dolor (AU)

Objectives: To quantify anxiety and immediate and late pain, efficacy of the common analgesic methods, and complications. Methods: 117 patients were randomized to three groups: 1(39): lubricant gel; 2 (38): intrarectal lidocaine gel; 3 (40): anesthetic blockage with 1% lidocaine. Complications and immediate and late pain were collected, these latter with a visual analogic scale. Results: 70% of the patients were not much anxious. We did not find significant differences between the analgesia achieved in group 1 (4.37± 2.41) and group 2 (4.22± 2.46), but we found with group 3 (1.88± 2.03). Mean pain score the afternoon after biopsy was lower in group 3 (2.08± 2.28) than in groups 1 and 2 (4.06± 2.80 and 2.42± 2.03), without statistical significance. The patients did not show a difference in pain during the pass of the transrectal transducer, varying between 2.34 for group 3 and 3.38 for group 2. Grouped by sphincter tone we find differences (low 2.71± 2.76, medium 3.23± 2.38, high 4.99+- 2.22). Patients feeling very nervous before the test had a pain score of 4.98± 2.57, significantly greater than the pain of those not feeling nervous (2.59± 2.21). We did not find differences in complications between the three groups. Conclusions: The use of intrarectal lidocaine gel did not demonstrated being more effective in pain control in our series than the use of lubricant gel, but lidocaine injected into the apex and seminal vesicles was. Sphincter tone and pre-test anxiety are the most determinants factors for pain (AU)