Does periprostatic block reduce pain during transrectal prostate biopsy? A randomized, placebo-controlled, double-blinded study

• Published in: International urology and nephrology 2010-03, Vol.42 (1), p.23-27
• Main Authors: Ingber, Michael S., Ibrahim, Ibrahim, Turzewski, Cynthia, Hollander, Jay B., Diokno, Ananias C.
• Format: Article
• Language: English
• Subjects: Anesthetics, Local - administration & dosage; Biopsy, Needle - adverse effects; Biopsy, Needle - methods; Double-Blind Method; Humans; Lidocaine - administration & dosage; Male; Medicine; Medicine & Public Health; Nephrology; Nerve Block; Pain - etiology; Pain - prevention & control; Prostate - innervation; Prostate - pathology; Rectum; Urology; Urology - Original Paper
• ISSN: 0301-1623; 1573-2584
• DOI: 10.1007/s11255-009-9621-2

Introduction Currently, the use of local anesthetic at the time of transrectal ultrasound-guided biopsy of the prostate is not universally accepted, as the needle injection itself causes pain. In prior studies, lidocaine was compared to placebo in separate patient groups. We present the first study to evaluate both lidocaine and placebo injected in each patient. Materials and methods Fifty patients received periprostatic injections of both lidocaine and placebo, randomized to separate sides of the prostate, in a randomized, double-blind, placebo-controlled trial design. Injections were delivered at the angle between the seminal vesicle and prostate on each side. Patients graded pain on a visual analog scale (VAS) (0–10) after injections and after each biopsy. Patients were surveyed to evaluate overall pain and discomfort before discharge. We used Student’s t -test to compare the mean VAS scores between lidocaine and placebo. Results The mean (SD) VAS after biopsy was 1.9 (1.4) on the lidocaine side and 2.3 (1.4) on the placebo side ( P  = 0.202). Pain after the injection itself was similar to pain after biopsy, with the mean (SD) VAS of 2.4 (1.6) and 2.2 (1.7) after lidocaine and placebo injections, respectively ( P  = 0.546). None of the differences were statistically significant. Twenty-nine (59.2%) patients reported no pain at the time of discharge. Conclusions Pain experienced during transrectal biopsy of the prostate is mild and is not significantly lowered with periprostatic nerve block. Pain from injection itself is similar to pain from core biopsies. Pain from transrectal ultrasound-guided biopsy of the prostate is well tolerated with no anesthesia.