title: Periprostatic infiltration with local anesthesia during transrectal ultrasound-guided prostate biopsy is safe, simple, and effective: a pilot study.
abstract: OBJECTIVE
  Transrectal ultrasound (TRUS)-guided prostate needle biopsy is the standard procedure to diagnose prostate cancer. It can be associated with significant discomfort and pain. We evaluated if periprostatic infiltration with local anesthetic reduces this discomfort.
  
  
  METHODS
  72 patients underwent TRUS-guided prostate needle biopsy. All patients had 12 cores, with four prostatic zones of biopsies. In 25 consecutive patients (G1) with a median prostate size of 47 cc, no anesthesia was given; while in 47 sequential patients (G2) with a median prostate size of 50 cc, 2 ml of 2% lidocaine was infiltrated in the periprostatic area around the neurovascular bundle using 20-cm-long, 22-gauge needle on both sides as guided by color Doppler. Biopsies were performed in standard fashion. Discomfort was graded on a scale from 0 to 10 with 0 meaning no discomfort, 1-3 mild, 4-6 moderate, and 7-10 severe.
  
  
  RESULTS
  12/25 (48%) of G1 patients reported no discomfort compared to 70% in G2 (P=.025). Mild discomfort was reported in 5/25 (20%) patients of G1 and 9/47 (19%) patients of G2. Moderate or severe discomfort was reported in 8/25 (32%) patients and 5/47 (11%) patients in G2 (P=.039). Prostate size did not affect degree of discomfort within each group and between both subgroups. No adverse reactions were observed secondary to lidocaine infiltration.
  
  
  CONCLUSIONS
  Periprostatic infiltration with local anesthesia at the time of TRUS-guided prostate needle biopsy significantly reduces discomfort. It is easy to perform, safe, and should be considered in all patients irrespective of the prostate size.
authors.affiliation: Department of Surgery, Division of Urology, Medical Center, American University of Beirut, P.O. Box 11-0236, Riad Solh, Beirut, Lebanon. mb30@aub.edu.lb
authors.forename: Muhammad A
authors.initials: MA
authors.lastname: Bulbul
authors.forename: Maurice C
authors.initials: MC
authors.lastname: Haddad
authors.forename: Raja B
authors.initials: RB
authors.lastname: Khauli
authors.forename: Kamal
authors.initials: K
authors.lastname: Hemady
authors.forename: Ahmad
authors.initials: A
authors.lastname: Shaar
authors.forename: Riad
authors.initials: R
authors.lastname: Khouzami
authors.forename: Wassim
authors.initials: W
authors.lastname: Wazzan
mesh_terms: D000772:Anesthesia, Local / Q000009:adverse effects; D001707:Biopsy, Needle / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D010865:Pilot Projects; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology*; D018084:Ultrasonography, Interventional / Q000009:adverse effects / Q000379:methods*