Efficacy of intrarectal lidocaine hydrochloride gel for pain control in patients undergoing transrectal prostate biopsy

Kim²,

et al. 2006

Int J of Urology

Aim : This study was designed to compare the effectiveness of intrarectal lidocaine gel versus periprostatic lidocaine injection during transrectal ultrasound (TRUS)-guided prostate biopsy. Methods : Ninety men undergoing transrectal prostate biopsy from July through December 2004 were randomized into three groups of 30 patients each. Before the biopsy, patients in Group 1 received 20 mL of 2% lidocaine gel intrarectally; patients in Group 2 received 5 mL (2.5 mL per side) of 2% lidocaine solution injected near the junction of the seminal vesicle with the base of the prostate (along the neurovascular bundles), and patients in Group 3 (control group) received 5 mL (2.5 mL per side) of normal saline injected along the neurovascular bundles. Pain level after the biopsy was assessed using a 10-point linear visual analog scale (VAS). Results were statistically compared by the Wilcoxon Rank Sum test. Results : Patients in Group 2 had significantly lower VAS scores than those in Group 3 (3.6 ± 2.1 vs 5.8 ± 1.9, P < 0.0001), but those in Group 1 did not (5.5 ± 2.7 vs 5.8 ± 1.9, P = 0.67). Gross hematuria, rectal bleeding, and hemospermia occurred in 36 (40.0%), 6 (7%) and 5 (6%) patients. One patient had temporary vasovagal syncope. No patient reported febrile urinary tract infection or urinary retention. Conclusions : Periprostatic injection of local anaesthetic is a safe technique that significantly reduces pain during prostate biopsy, whereas intrarectal lidocaine injection did not reduce pain. This safe, simple technique should be applied in men undergoing TRUS-guided prostate biopsy to limit patient discomfort.

Section: Discussionmentioning

confidence: 50%

Effectiveness of local anaesthesia techniques in patients undergoing transrectal ultrasound‐guided prostate biopsy: A prospective randomized study

Kim²,

et al. 2006

Int J of Urology

Prostate Cancer Prostatic Dis

“…The trials were ineligible in seven studies because they were single arm or nonrandomized studies, 12,[20][21][22] had small patient numbers (o10) within each study arm 23 or had used a non-validated or categorical pain scale. 15,24 Eight studies were excluded because complete data on the mean or standard deviation of the pain scores of the patients was not provided or obtainable. 16,[25][26][27][28][29][30][31] Two studies were excluded as they were duplicates.…”

Section: Study Selectionmentioning

confidence: 99%

A meta-analysis of local anesthesia for transrectal ultrasound-guided biopsy of the prostate

Tiong

Liew

Samuel

et al. 2007

This meta-analysis evaluated the efficacy and safety of periprostatic nerve block (PPNB) and intrarectal local anesthestic (IRLA) gel in alleviating pain during prostate biopsy. Electronic databases MEDLINE, Cochrane Central Register of Controlled Trials and EMBASE were searched to identify all randomized controlled trials comparing PPNB with periprostatic placebo injection, no injection or with IRLA. Studies for inclusion were identified and extracted by two authors independently. The main outcome measure was patients' assessment of mean pain scores on a 10-point scale at the end of the biopsy procedure. Secondary outcomes were complications and adverse events. Continuous data from the trials were combined by calculating the weighted mean difference (WMD) with its 95% confidence interval. In total, 25 studies met the inclusion criteria. Twenty studies involving 1685 patients compared PPNB with either no anesthesia or with placebo injection controls, showing a significant reduction in pain score in the anesthetic group (WMD À2.09, 95% CI À2.44 to À1.75, Po0.00001). Five studies with 466 patients compared IRLA and control. Although IRLA was associated with pain reduction, the effect size was not statistically significant (WMD À0.22, 95% CI À0.56 to 0.12). Six studies with 872 patients compared PPNB with IRLA, showing a significant pain reduction in the former group (WMD À1.53, 95% CI À2.67 to À0.39, P ¼ 0.008). No trials reported an increase in complications in the treatment arms. In conclusion, the evidence from randomized controlled trials shows that local anesthetic given as a PPNB, but not as an intrarectal instillation, is effective and safe in alleviating pain from transrectal ultrasound biopsy of the prostate.

“…The overall complication rate was small in our study compared with other series. 2,3,15,18,27,28 In our experience, the presence of anorectal anomalies such as anal stenosis posthemorrhoidectomy or active diseases such as fistula-in-ano or fissue-in-ano makes TRS-guided prostate biopsy a particularly painful procedure. These patients require some form of local anesthestic prior to the procedure.…”

Section: Discussionmentioning

confidence: 97%

Patients' tolerance and early complications of transrectal sonographically guided prostate biopsy: Prospective study of 300 patients

Sheikh

Hussein

Kehinde

et al. 2005

J. Clin. Ultrasound