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Combination of lidocaine suppository and periprostatic nerve block during transrectal prostate biopsy: A prospective randomized trial
Author(s) -
Lunacek Andreas,
Mrstik Christof,
Simon Josef,
Frauscher Ferdinand,
Schwentner Christian,
Radmayr Christian,
Horninger Wolfgang,
Plas Eugen
Publication year - 2014
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/iju.12542
Subject(s) - medicine , suppository , lidocaine , visual analogue scale , prostate biopsy , nerve block , biopsy , prostate , urology , rectal examination , anesthesia , surgery , radiology , cancer , pharmacology
Objective To assess the most effective local analgesia during transrectal ultrasound‐guided prostate biopsy. Methods A total of 123 consecutive patients undergoing transrectal ultrasound‐guided prostate biopsy for elevated prostate‐specific antigen levels and/or a suspicious digital rectal examination were randomized to three groups. Patients received a 60‐mg lidocaine suppository (group 1, n = 41), a periprostatic nerve block (10‐mL injection of lidocaine hydrochloride; group 2, n = 41) or a combination of both (group 3, n = 41) before a 10‐core transrectal ultrasound‐guided biopsy. A total of 80.5% ( n = 99) of the patients underwent their first biopsy, 27.1% ( n = 22) their second and 2.4% ( n = 2) the third. Pain was evaluated on a 10‐point visual analog scale for each step of the procedure. Results Prostate‐specific antigen values ranged from 0.39 to 90.1 (mean [ SD ] 8.76 ng/mL [11.08 ng/mL]). Comparison of the median visual analog scale scores between groups 1 and 2 showed a significant difference ( P = 0.004). The differences in the outcomes between groups 1 and 3 ( P = 0.001), and groups 2 and 3 ( P = 0.001) were also significant. Patients of group 3 had the best output corresponding to the pain sensations and therefore the lowest visual analog scale scores. Conclusion The combination of lidocaine suppository and periprostatic lidocaine infiltration is more effective for pain control than either lidocaine suppository or periprostatic lidocaine infiltration alone in patients undergoing transrectal ultrasound‐guided prostate biopsy.