title: Does the intrarectal instillation of lidocaine gel before periprostatic neurovascular bundle block during transrectal ultrasound guided prostate biopsies improve analgesic efficacy? A prospective, randomized trial.
abstract: OBJECTIVE
  We assessed the analgesic effect of additional intrarectal lidocaine gel instillation during transrectal ultrasound guided prostate biopsy and identified the procedural steps that benefit from lidocaine gel instillation.
  
  
  METHODS
  A total of 250 consecutive patients scheduled for prostate biopsy were randomized into 2 groups. In the 125 group 1 patients lidocaine gel was instilled intrarectally before periprostatic neurovascular bundle block. The 125 patients in group 2 underwent only periprostatic neurovascular bundle block without lidocaine gel instillation. Of the 250 patients 90 in group 1 and 113 in group 2, in whom 12 systematic cores were obtained, were enrolled for data analysis. Pain was assessed using a visual analog scale during periprostatic neurovascular bundle block (visual analog scale 1), during biopsy (visual analog scale 2) and 20 minutes after biopsy (visual analog scale 3). Differences between the visual analog scale scores of the 2 groups at each procedural step were evaluated using the unpaired t test with p<0.05 considered significant.
  
  
  RESULTS
  In terms of pain experienced during the 3 procedural steps scores were significantly different during biopsy (p<0.01). Visual analog scale scores of patients in group 1 showed a tendency to be lower than the scores of patients in group 2 during periprostatic neurovascular bundle block and 20 minutes after biopsy (p=0.11 and 0.20, respectively).
  
  
  CONCLUSIONS
  Intrarectal lidocaine gel instillation before periprostatic neurovascular bundle block produces a significant additional analgesic effect during biopsy. The procedure is simple, safe and rapid, and it should be considered in all patients undergoing transrectal ultrasound guided prostate biopsy.
authors.affiliation: Department of Radiology, College of Medicine, Seoul National University Hospital, Gyeonggi-do, Korea.
authors.forename: Tae Jin
authors.initials: TJ
authors.lastname: Yun
authors.forename: Hak Jong
authors.initials: HJ
authors.lastname: Lee
authors.forename: Seung Hyup
authors.initials: SH
authors.lastname: Kim
authors.forename: Sang Eun
authors.initials: SE
authors.lastname: Lee
authors.forename: Jeong Yeon
authors.initials: JY
authors.lastname: Cho
authors.forename: Chang Kyu
authors.initials: CK
authors.lastname: Seong
mesh_terms: D000285:Administration, Rectal; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001707:Biopsy, Needle; D005782:Gels; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D010147:Pain Measurement; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000473:pathology*; D036761:Ultrasound, High-Intensity Focused, Transrectal
chemical_list: D000779:Anesthetics, Local; D005782:Gels; D008012:Lidocaine