Comparison of traditional basal and apical periprostatic block: impact on injection pain and biopsy pain.
OBJECTIVE
To compare the pain of injection and biopsy when lidocaine is injected periprostatically either at a basal or apical site, as the former is commonly used to anaesthetise the prostate, based on several reports showing that it can eliminate most of the pain associated with prostate biopsy, and this site has been favoured over apical injection because the nerves enter the prostate from the basal aspect.


METHODS
In all, 143 patients scheduled for biopsy were randomized to receive a periprostatic block either at the apex or base of the prostate. Immediately before biopsy 5 mL of 1% lidocaine was injected under transrectal ultrasonographic (TRUS) guidance into the periprostatic nerves bilaterally. Patients were immediately given a 100 mm visual analogue scale (VAS, 0-100) to assess the pain associated with both the block and the subsequent biopsy.


RESULTS
The mean VAS scores for the anaesthetic block were 21.1 and 22.0 (P = 0.79) and the biopsy VAS scores were 17.6 and 28.7 (P < 0.001) for the apical and basal groups, respectively. There was no statistically significant difference between patients who had a 12- or 20-core biopsy.


CONCLUSIONS
Apical periprostatic injection with anaesthetic provides better anaesthesia for TRUS biopsy than basal injection, and without increasing the pain associated with injection at the potentially more sensitive apical site.
Nguyen
Carvell T
CT
Glickman Urological Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue A100, Cleveland, OH 44195, USA.
Jones
J Stephen
JS
D000779:Anesthetics, Local / Q000008:administration & dosage*; D006801:Humans; D007267:Injections / Q000009:adverse effects*; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D009407:Nerve Block / Q000379:methods*; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging*; D016896:Treatment Outcome; D014463:Ultrasonography; D036761:Ultrasound, High-Intensity Focused, Transrectal / Q000009:adverse effects*
D000779:Anesthetics, Local; D008012:Lidocaine