Which anaesthesia should be recommended for prostate biopsy?
OBJECTIVE
Although transrectal ultrasound-guided prostatic biopsies are associated with significant discomfort and pain, most urologists do not use any kind of anaesthesia. We therefore compared the efficacy of two local anaesthetics, namely, the rectal administration of lidocaine gel and lidocaine periprostatic infiltration prior to biopsies.


METHODS
Three hundred and fifty-six randomized patients received either 15 mL of 2% lidocaine gel administered intrarectally ten minutes before prostate biopsies in group 1 (180 patients) or 10 mL of 1% lidocaine given under ultrasound guidance in two periprostatic injections of 5 mL, four minutes before the biopsies in group 2 (176 patients). A visual analogue scale (VAS) was used to assess the pain score during anaesthesia (VAS 1), during the biopsies (VAS 2) and 30 minutes after them (VAS 3).


RESULTS
Patients receiving lidocaine gel experienced statistically less pain than the lidocaine injection group for mean VAS 1 (0.1 vs 1.4, p < 0.0001) and mean VAS 3 (0.8 vs 1.4, p < 0. 001) but VAS 2 showed no statistically significant difference (2.0 vs 2.1). No major morbidity was noted with either anaesthetic.


CONCLUSIONS
Rectal administration of lidocaine gel is both safe, simple and effective and results are more satisfactory than with lidocaine periprostatic infiltration.
Department of Urology, University Hospital, Pointe-A-Pitre, Guadeloupe, French West Indies. mallick@caramail.com
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Mallick
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Braud
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Fofana
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Humbert
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Clervil
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Blanchet
D000285:Administration, Rectal; D000368:Aged; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001706:Biopsy; D003657:Decision Making; D019160:Endosonography; D019430:Guadeloupe / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007267:Injections; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D010146:Pain / Q000175:diagnosis / Q000453:epidemiology; D010147:Pain Measurement; D017060:Patient Satisfaction; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology*; D011469:Prostatic Diseases / Q000175:diagnosis; D012007:Rectum
D000779:Anesthetics, Local; D008012:Lidocaine