title: Periprostatic local anesthesia in transrectal ultrasound-guided prostate biopsy: is it possible to improve pain tolerance?
abstract: OBJECTIVE
  Evaluate objectively pain tolerance in transrectal ultrasound-guided prostate biopsy (TRUS) using local periprostatic anesthesia applied intrarectally, compared to the conventional method.
  
  
  METHODS
  Forty patients were submitted to TRUS-guided prostate biopsy due to clinical suspicious of neoplasia. Patients were randomized in 2 groups: group-I, with 20 patients submitted to local anesthesia by 4 periprostatic injection of 2.5 mL 1% lidocaine, without epinephrine, TRUS-guided; and group-II, with 20 controls, with no sedatives or analgesia. After biopsy, patients were questioned about pain intensity during the procedure, using a grading scale from 0 to 5, correlating numbers, colors, and pain intensity. Pain related to probe manipulation or biopsy punctures, acceptance of an eventual re-biopsy, side effects of the drug used, and later complications of the procedure were also evaluated.
  
  
  RESULTS
  Both groups were consistent comparing PSA levels, and prostate volume. As for pain intensity, 18/20 patients had severe or intolerable pain on the group submitted to conventional biopsy, while for those submitted to periprostatic blockage this event occurred in 3/20 patients (Chi(2 ) =22.50; p<0.01). The most important pain component was manipulation of the transrectal probe in 28% of patients, and puncture itself in 72%. Acceptance of re-biopsy as a pain evaluation criterion occurred in only 45% of patients submitted to conventional biopsy, compared to 100% of those submitted to periprostatic anesthesia (Chi (2)=15.17; p<0.01).
  
  
  CONCLUSIONS
  TRUS-guided prostate biopsy is a traumatic and painful experience, but the periprostatic blockage use is clearly associated with more tolerance and patient comfort during the exam.
authors.affiliation: Division of Urology, ABC Medical School, Santo André, SP, Brazil. telmamsm@icr.hcnet.usp.br
authors.forename: M Tobias
authors.initials: MT
authors.lastname: Machado
authors.forename: Augusto J
authors.initials: AJ
authors.lastname: Aragão
authors.forename: Alexandre O
authors.initials: AO
authors.lastname: Rodrigues
authors.forename: Eric R
authors.initials: ER
authors.lastname: Wroclawski