Lidocaine suppositories for prostate biopsy

• Published in: BJU international 2005-11, Vol.96 (7), p.1028-1030
• Main Authors: Fink, Klaus G., Gnad, Andrea, Meissner, Phillip, Götschl, Robert, Schmeller, Nikolaus T.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; anaesthesia; Analgesics; Biological and medical sciences; Biopsy - economics; Biopsy - methods; Costs and Cost Analysis; gel; Gels - economics; Genital system. Mammary gland; Humans; Investigative techniques, diagnostic techniques (general aspects); Lidocaine; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Pain Measurement; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Patient Satisfaction; prostate; Prostate - pathology; prostate biopsy; Prostatic Neoplasms - pathology; suppositories; Suppositories - economics; Tumors of the urinary system; Urinary tract. Prostate gland
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/j.1464-410X.2005.05784.x

OBJECTIVES To evaluate, in a randomized prospective study, the efficiency of transrectal lidocaine suppositories to reduce pain during transrectal prostate biopsy, as suppositories allow longer for the agent to be effective. PATIENTS AND METHODS In all, 100 patients were randomized to receive either a placebo suppository or 10 mL of 2% (200 mg) lidocaine gel rectally 10 min before biopsy, or a suppository containing 60 mg lidocaine 1 or 2 h before biopsy. Costs (in euros) per application were 0.82 for gel and 0.63 for suppositories. In all patients the same 10‐core biopsy technique was used. Pain was evaluated using a visual linear pain scale ranging from 0 to 100 points; the patient's side of the scale did not show the number of points. RESULTS The mean pain scores in the placebo, lidocaine gel, and lidocaine suppositories applied 1 h and 2 h before biopsy were 36.2, 40.9, 29.2 and 21.2, respectively. Thus patients with no anaesthesia reported 25% more pain than those receiving lidocaine suppositories 1 h before and 71% more pain than those receiving lidocaine suppositories 2 h before biopsy (P = 0.002). CONCLUSIONS Lidocaine suppositories at a lower dose and with longer to take effect can be used to reduce pain significantly more effectively than the commonly used gel. As suppositories are easy to use and cheap, they are recommended in daily routine prostate biopsy.