Tolerability of prostate transrectal biopsies using gel and local anesthetics: results of a randomized clinical trial.
OBJECTIVE
To evaluate the role of intrarectal EMLA, a new topical anesthetic cream, and lidocaine gel as local anesthesia during transrectal prostate biopsy and to observe whether gel temperature can improve pain control.


METHODS
A series of 210 consecutive patients were randomized. Group 1 (N = 60) underwent intrarectal instillation of EMLA cream, group 2 (N = 50) 2.5% lidocaine gel, group 3 (N = 40) placebo, and group 4 (N = 60) no treatment. Patients in groups 2 and 3 were subdivided into subgroups according to instillation of warm or cooled gel. Pain control was assessed by a 10-point visual analog scale.


RESULTS
The median pain scores were 2.6 in group 1, 3.8 in group 2, 3.9 in group 3, and 3.6 in group 4. In 16 patients (7.6%), the procedure was suspended because of pain: none group 1, 6.0% in group 2, 10% in group 3, and 15% ing group 4. The temperature of the lidocaine gel did not affect tolerability.


CONCLUSIONS
Intrarectal instillation of EMLA cream is a simple, safe, and effective method of local anesthesia during transrectal prostate biopsy, superior to lidocaine gel, placebo, and no treatment.
Galosi
Andrea B
AB
Institute of Urology, University of Ancona School of Medicine, Azienda Ospedaliera Umberto 1st, Ancona, Italy.
Minardi
Daniele
D
Dell'atti
Lucio
L
Yehia
Mamhoud
M
Muzzonigro
Giovanni
G
D000285:Administration, Rectal; D000368:Aged; D000772:Anesthesia, Local / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage; D001707:Biopsy, Needle / Q000379:methods*; D005782:Gels / Q000008:administration & dosage; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis* / Q000453:epidemiology; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery; D012016:Reference Values; D018570:Risk Assessment; D016037:Single-Blind Method; D016896:Treatment Outcome
D000779:Anesthetics, Local; D005782:Gels; D008012:Lidocaine