Periprostatic lidocaine infiltration and/or synthetic opioid (meperidine or tramadol) administration have no analgesic benefit during prostate biopsy. A prospective randomized double-blind placebo-controlled study comparing different methods.
OBJECTIVE
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.


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).


CONCLUSIONS
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.
Bozlu
Murat
M
Department of Urology, University of Mersin School of Medicine, Mersin, Turkey. muratbozlu@yahoo.com
Atici
Sebnem
S
Ulusoy
Ercüment
E
Canpolat
Bülent
B
Cayan
Selahittin
S
Akbay
Erdem
E
Schellhammer
Paul F
PF
Oral
Uğur
U
D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001706:Biopsy / Q000009:adverse effects*; D004311:Double-Blind Method; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008614:Meperidine / Q000008:administration & dosage*; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D014147:Tramadol / Q000008:administration & dosage*
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D014147:Tramadol; D008012:Lidocaine; D008614:Meperidine