Prospective study comparing two methods of anaesthesia for prostate biopsies: apex periprostatic nerve block versus intrarectal lidocaine gel: review of the literature.
BACKGROUND
Studies have demonstrated the need for pain control during multiple transrectal prostate biopsies. Due to encountered published results on periprostatic nerve block, we prospectively evaluated the efficacy and safety of periprostatic local anaesthesia at the apex in comparison to intrarectal lidocaine gel.


METHODS
From January 2001 to January 2002 110 patients underwent prostate biopsy. Patients were randomized to receive 10 cc of either 2% lidocaine gel intrarectally (Group 1) or 10 cc of 1% lidocaine solution injected under ultrasound guidance for bilateral periprostatic nerve block at the apex (Group 2). Pain during biopsy was assessed using a 10-point linear visual analog pain scale and a 5-point digital visual pain scale (continuous variables). Statistical analysis of pain scores was performed using the Student t-test.


RESULTS
96 patients fitted the inclusion and presented no exclusion criteria. 43 patients composed group 1, and 53 patients group 2. The mean pain score was 2.76+/-1.69 and 1.73+/-1.26 for group 1 and 2, respectively for the 10-point linear visual analog pain scale (p=0.001). The mean pain score was 2.26+/-0.82 and 1.62+/-0.56 for groups 1 and 2, respectively for the 5-point digital visual pain scale (p<0.001). There was no difference in mean patient age (p=0.348), prostate size (p=0.899), serum PSA (p=0.932), and complications when comparing both groups. The number of biopsies per patient was significantly higher in group 2 (p=0.006), but pain scores in each scale were significantly less.


CONCLUSIONS
Periprostatic nerve block at the apex is superior to intrarectal lidocaine gel for controlling pain during transrectal prostate biopsy, with no increased complications. This technique should be recommended for those patients without anal or rectal inflammatory diseases.
Rodriguez
Alejandro
A
Service d'Urologie, CHU Pontchaillou, Rue Henri Le Guilloux, 35033 Rennes, France. armbkdd@yahoo.com
Kyriakou
Georges
G
Leray
Emmanuelle
E
Lobel
Bernard
B
Guillé
François
F
D000285:Administration, Rectal; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001707:Biopsy, Needle / Q000379:methods; D005782:Gels; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D011446:Prospective Studies; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000473:pathology*; D016896:Treatment Outcome; D014463:Ultrasonography
D000779:Anesthetics, Local; D005782:Gels; D008012:Lidocaine