title: Tolerance of local anesthetic for transrectal ultrasound-guided prostate biopsy: our experience and a literature review.
abstract: OBJECTIVE
  To determine whether local anesthetic injection or gel reduced pain during transrectal ultrasound-guided prostate biopsies and whether there was significant difference between quadrant and apex-only anesthesia.
  
  
  METHODS
  Between September 2001 and May 2002, 240 male patients with elevated prostate-specific antigen and (or) abnormal digital rectal examination were randomized into 1 of 4 groups: 1) transrectal lidocaine gel, 2) quadrant lidocaine injections, 3) apex-only lidocaine injections, or 4) no local anesthetic. Patients scored their pain on a numerical rating scale where 0 indicated no pain and 10 indicated worst pain. We analyzed mean and standard deviations of scores, using a 1-way analysis of variance (ANOVA) and post hoc multiple comparisons with Tukey's honestly significant difference (HSD) studentized range test to determine whether there were significant differences across the groups.
  
  
  RESULTS
  There was no significant difference between local anesthetic gel (mean 3.1, SD 1.9) and no anesthetic (mean 3.5, SD 1.9) or between quadrant (mean 1.7, SD 1.7) and apex-only (mean 2.0, SD 1.8) local anesthetic injections. There was significant difference between quadrant injections (mean 1.7, SD 1.7) and no local anesthetic (mean 3.5, SD 1.9) and between apex-only injections (mean 2.0, SD 1.8) and no local anesthetic (mean 3.5, SD 1.9).
  
  
  CONCLUSIONS
  There was significant pain reduction with local anesthetic injections but not with gel, and since there was no significant difference in efficacy between quadrant and apex-only injections, we recommend apex-only local anesthetic injections for transrectal ultrasound--guided prostate biopsies because it simplifies the injection procedure.
authors.affiliation: Ultrasound Department, St Paul's Hospital, Vancouver, British Columbia.
authors.forename: Miriam R E
authors.initials: MR
authors.lastname: Buckley
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Bryant
authors.forename: Jacqueline A
authors.initials: JA
authors.lastname: Brown
authors.forename: Pari
authors.initials: P
authors.lastname: Tiwari
authors.forename: Peter L
authors.initials: PL
authors.lastname: Cooperberg
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Wong
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001706:Biopsy / Q000379:methods; D005782:Gels / Q000627:therapeutic use*; D006801:Humans; D007267:Injections; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000517:prevention & control; D010147:Pain Measurement; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000473:pathology*; D018084:Ultrasonography, Interventional
chemical_list: D000779:Anesthetics, Local; D005782:Gels; D008012:Lidocaine