Perianal and intrarectal anaesthesia for transrectal biopsy of the prostate: a prospective randomized study comparing lidocaine-prilocaine cream and placebo.
OBJECTIVE
To assess the effectiveness of perianal and intrarectal lidocaine-prilocaine cream for prostate biopsy.


METHODS
In a prospective, randomized, double-blind, placebo-controlled study, 200 consecutive patients were randomized to receive 5 mL lidocaine-prilocaine cream or 5 mL placebo peri-anally and transrectally before transrectal ultrasonography (TRUS)-guided prostate needle biopsy (mean number of cores, 12). The men were asked to grade the pain when the TRUS probe was inserted and during the biopsy procedure using a 10-point linear visual analogue pain scale.


RESULTS
At probe insertion, men in the anaesthetic group reported a significantly lower mean pain level than men in the placebo group (0.3 vs 1.6, P < 0.001). Men who had anaesthetic also reported less pain during biopsy punctures (1.8 vs 3.2, P < 0.001). Stratifying results by age, younger men (< 67 years) benefited more from anaesthesia during probe insertion (0.9 vs 1.7; P = 0.04) and biopsy (1.8 vs 4.0, P < 0.001) than older men (1.0 vs 1.1, P = 0.7 and 1.9 vs 2.4, P = 0.3, respectively). There were only minor complications, and these were not significantly different between the groups.


CONCLUSIONS
Topical anaesthesia with prilocaine-lidocaine cream significantly reduced pain at transrectal probe insertion and during the biopsy procedure.
Raber
Marco
M
Istituto Scientifico Ospedale San Raffaele, Urology, Milan, Italy. raber.marco@hsr.it
Scattoni
Vincenzo
V
Roscigno
Marco
M
Rigatti
Patrizio
P
Montorsi
Francesco
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019162:Anesthetics, Combined / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001707:Biopsy, Needle / Q000379:methods; D004311:Double-Blind Method; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D000077442:Lidocaine, Prilocaine Drug Combination; D008297:Male; D008875:Middle Aged; D009824:Ointments; D010146:Pain / Q000517:prevention & control*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control; D011318:Prilocaine / Q000008:administration & dosage*; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000473:pathology*; D018084:Ultrasonography, Interventional
D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D000077442:Lidocaine, Prilocaine Drug Combination; D009824:Ointments; D011318:Prilocaine; D008012:Lidocaine