Does pericapsular lignocaine reduce pain during transrectal ultrasonography‐guided biopsy of the prostate?

Abstract

Objective To evaluate whether injection with pericapsular lignocaine before transrectal ultrasonography (TRUS)-guided biopsy reduces the perceived pain of prostatic biopsy. Patients and methods The study included 121 patients referred for TRUS-guided biopsy of the prostate; 27 underwent biopsy with no previous injection and 94 were randomized to pericapsular injection with either 1% lignocaine or a placebo (saline). Both patient and operator were unaware of the content of the injection. The injection was delivered under TRUS guidance to the apex of the prostate. Routine sextant biopsies were taken using an 18 G needle in a spring-loaded biopsy gun. A validated pain scale, the NRS11 (0, no pain, to 10, unbearable pain), was used to record the pain of each biopsy.Results No significant placebo effect was detected between the 'no injection' and the placebo-injection group, with mean (95% confidence interval) pain scores of 3.58 (2.77-4.39) and 4.01 (3.46-4.51), respectively, using the unpaired Student's t -test ( P = 0.409). There was a statistically significant lower mean pain score in the lignocaine group, at 2.54 (2.00-3.10), than in the placebo-injection group ( P < 0.001). Conclusion Pericapsular injection with 1% lignocaine significantly reduces the perceived pain of TRUS-guided prostatic biopsy.

Three different techniques for administering analgesia during transrectal ultrasound-guided prostate biopsy: a comparative study

“…There were no severe complications that required hospitalization in any of the patients. Similarly, in several studies, it has been shown that the use of periprostatic blockage with an intrarectal gel is better than placebo (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). Entonox, which is a gas anaesthetic material (50% nO and 50% O 2 mixture), is widely used in the UK during delivery, in minor procedures treating trauma, and in emergencies, because it provides short-term anaesthesia.…”

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

“…In two studies, a five-point pain scale was used and the scores in these studies were converted to a 10-point pain scale to facilitate comparison. 14,19 If the pain ratings in a study were taken at different times of the biopsy procedure, only the pain scores taken immediately at the end of the biopsy procedure were extracted for analysis. The secondary outcome measures were complications associated with the use of local anesthesia.…”

“…32,33 A total of 25 trials were eventually evaluated. 19,56,57 Trials identified as potentially relevant and screened (n= 61) Trials retrieved for detailed evaluation (n=42) Trials excluded as not relevant (n=19)…”

“…Randomization methods were judged to be adequate in 10 studies. [34][35][36]42,44,[51][52][53]19,56 They were not specified in the remaining 15 trials. 14,[37][38][39][40][41]43,[45][46][47][48][49][50]54,55 For the trials assessing the efficacy of PPNBs, two types of controls were used.…”

“…Trials that used placebo injections as controls were double-blinded, whereas trials that used no anesthesia as controls had no concealment of treatment allocation. For the 10 trials with placebo injections, concealment of allocation was judged to be adequate with central office randomization in six studies, 35,42,46,55,19,56 but was not used or unclear in the remaining four. 14,40,47,48 For these 10 studies, there was also concern that normal saline placebo injections may cause additional injection-related pain 41 and pain scores from placebo injections alone had been measured to be between 1.1 and 1.8.…”