Local anesthesia in transrectal ultrasound-guided prostate biopsy: Apical periprostatic nerve block versus endorectal lidocaine gel A randomized controlled trial about 100 patients

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Published Mar 31, 2010
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Vol. 88 No. 4 (2010): Issue Apr 2010

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M.I BEYROUTI
R BEYROUTI
N AFFES
A KHEBIR
I FKI
R BEYROUTI
Z DAMAK
M AZZAZA
Y DAMMAK
M.B KHALIFA
M.B. AMAR
Sallami Sataa
Mejri Ramzi
Chelif Mohamed
Ben Salah Imed
Ben Rhouma Sami
Hafsia Ghassen
Nouira Yassine
Horchani Ali

Abstract

 Background: Intrarectal lidocaine application and apical periprostatic nerve block are a safe technique that significantly reduces pain during transrectal prostate biopsy
Aim:We compare prospectively the effectiveness of intrarectal lidocaine gel versus periprostatic lidocaine injection during transrectal ultrasound -guided prostate biopsy.
Methods: From June 2005 to February 2006, 100 consecutive patients underwent prostatic biopsies. Patients were randomized to receive 10 cc of 2% lidocaine gel in endorectally (Group I), 10 cc of 1% lidocaine solution injected into the prostate apex to induce bilateral periprostatic nerve block (Group II), or intrarectal 10 cc of
ultrasound gel as placebo (Groupe III). Pain was evaluated by a 10- point linear visual analogue pain scale (VAS), and a 5-point digital visual scale (DVS). The side effects of the drugs and complications were also evaluated.
Results: The three groups counted respectively: 33, 33 and 34 patients and were statically comparable as the age, prostate volume, PSA level and the number of biopsies.
The mean pain score on the VAS was respectively 4,1; 4,6 and 3,5 for the three groups.
The DVS score was 2,5; 2,8 and 2,15 (p < 0,001). Pain scores were significantly lower in Group 3 and equivalent between Groups 1 and 2.
There is no difference in complication rate between the three groups.
Conclusion: Compared to intrarectal lidocaine application, apical periprostatic nerve block is a safe technique that significantly reduces pain during transrectal prostate biopsy, with no increase in the complication rate.

Keywords:

Prostate, Cancer, Biopsy, Anaesthesia, Pain, Randomized clinical trial

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