Combination of oral tramadol, acetaminophen and 1% lidocaine induced periprostatic nerve block for pain control during transrectal ultrasound guided biopsy of the prostate: a prospective, randomized, controlled trial.
OBJECTIVE
Prostate biopsy for diagnosing cancer can be painful. Tramadol is a centrally acting analgesic used to treat many pain disorders. We determined whether administering oral tramadol and acetaminophen combined with 1% lidocaine induced periprostatic nerve block would significantly decrease the pain experienced by patients during standard 10-core transrectal ultrasound guided needle biopsy of the prostate.


METHODS
A total of 60 men who presented for diagnostic prostate biopsy were randomized to receive placebo plus periprostatic 1% lidocaine as the control group of 30 or 75 mg tramadol/650 mg acetaminophen orally plus periprostatic 1% lidocaine as the experimental group of 30 before undergoing biopsy. Immediately after biopsy each patient was asked to rate the pain on a linear 10-point scale and a standard 6-point faces pain scale. Complications of pain medication administration in each group were noted and compared.


RESULTS
Pain medication administration was well tolerated by each study group except for lightheadedness/dizziness and itching in 1 patient each in the experimental group, and lightheadedness/dizziness in 1 patient in the control group. Overall patients in the experimental group reported a mean decrease +/- SD in the pain score of 2.3 +/- 2.4 on the scale of 1 to 10 (p = 0.0008) and 1.11 +/- 1.25 on the scale of 0 to 5 compared with scores in controls (p = 0.0009).


CONCLUSIONS
Administering 75 mg tramadol/650 mg acetaminophen orally with periprostatic 1% lidocaine before transrectal ultrasound guided prostate biopsy is a safe, easy and effective method of controlling pain during the biopsy procedure.
Pendleton
John
J
Division of Urology, University of Florida, Jacksonville, Florida 32209, USA.
Costa
Joseph
J
Wludyka
Peter
P
Carvin
Dolly M
DM
Rosser
Charles J
CJ
D000082:Acetaminophen / Q000008:administration & dosage*; D000284:Administration, Oral; D000368:Aged; D000700:Analgesics / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001707:Biopsy, Needle / Q000009:adverse effects; D004311:Double-Blind Method; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D006801:Humans; D007267:Injections; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement; D011446:Prospective Studies; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology*; D014147:Tramadol / Q000008:administration & dosage*; D014463:Ultrasonography
D000700:Analgesics; D000779:Anesthetics, Local; D004338:Drug Combinations; C478659:Ultracet; D000082:Acetaminophen; D014147:Tramadol; D008012:Lidocaine