Periprostatic Lidocaine Infiltration and/or Synthetic Opioid (Meperidine or Tramadol) Administration Have No Analgesic Benefit during Prostate Biopsy

Abstract

Objectives: To examine in a prospective, randomized, double-blind, placebo-controlled study the analgesic effect of periprostatic nerve block and/or intravenous synthetic opioid administration during a 12-core prostate biopsy. Patients and Methods: Patients were prospectively randomized to receive unilateral periprostatic lidocaine administration and/or intravenous synthetic opioid (meperidine or tramadol) administration. Placebo groups received sterile normal saline. Unilateral infiltration was performed and biopsy was begun on this side. The degree of pain was recorded using the visual analog scale/numeric analog scale (VAS/NAS) score before the procedure, during probe introduction into the rectum, during unilateral periprostatic nerve blockade, during the first 6-core biopsy and during the second 6-core biopsy, and 30 min after biopsy completion. Results: Most of the patients had mild or moderate pain (VAS/NAS <6) during the actual biopsy procedure. However, no significant differences existed between the groups with regard to the pain scores at any time (p > 0.05). Compared with pain scores, no significant differences existed between the first 6-core (blocked side) and second 6-core biopsies (p > 0.05). Conclusion: Periprostatic lidocaine infiltration and/or intravenous synthetic opioid analgesics are not beneficial in significantly reducing pain during biopsy. We think that most of the patients do have pain during biopsy, however the intensity of pain is tolerable and does not require analgesics.

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

“…From this pool, 17 publications were further excluded from analysis for the following reasons. 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.…”

Size of the transrectal ultrasound probe makes no difference in pain perception during TRUS-Bx under adequate local anesthesia

“…In our previous study, where we examined the pain experience of the whole procedure, we also failed to show any beneficial effect of intrarectal lidocaine gel anesthesia [7]. On the other hand, tramadol combined with periprostatic nerve block with injectable anesthetics has variously been reported to be beneficial [10] or not beneficial in the published literature [11]. Almost all of the studies published thus far have uniformly shown the superiority of local anesthesia with intraprostatic, periprostatic, or combined (intraprostatic ?…”

Is Only Perianal Anesthesia with Lidocaine-Prilocaine Cream Sufficient to Decrease the Pain during Transrectal Ultrasound-Guided Prostate Biopsy? A Prospective Randomized Study

“…3 in the control group. Similarly, Bozlu et al [16] suggested that pain during biopsy is tolerable and does not require analgesics. In our study, patients who received only perianal anesthesia also reported mean pain scores of probe insertion and overall scores of !…”