title: Topical prilocaine-lidocaine cream combined with peripheral nerve block improves pain control in prostatic biopsy: results from a prospective randomized trial.
abstract: OBJECTIVE
  To compare pain control results between periprostatic nerve block alone and combined with topical prilocaine-lidocaine cream as local anesthesia of prostate biopsy.
  
  
  METHODS
  Three hundred patients were randomized to receive PNB (group 1), topical anesthesia of the anal ring, anal canal, and anterior rectal wall combined with PNB (group 2) and placebo (group 3). Patients were asked to use scale of 0-10 to complete a visual analogue scale questionnaire about pain during probe insertion (VAS1), periprostatic infiltration (VAS2), and cores (VAS3).
  
  
  RESULTS
  Pain during probe insertion in group 2 was significantly less than in groups 1 and 3 (VAS1, 0.29 vs. 1.46 and 1.48; p<0.0001). Pain during periprostatic infiltration was also reduced in group 2 compared with group 1 (VAS2, 1.06 vs. 2.39; p<0.0001). Pain control was similar during biopsy in the PNB and combined groups (VAS3, 0.43 vs. 0.37; p=0.77) and was superior to group 3 (VAS3, 3.02; p<0.0001). In younger patients (cut off, median age 67 yr) these differences were still significant between groups 1 and 2 (VAS1, 1.95 vs.0.31; p<0.0001 and VAS2, 2.97 vs. 1,15; p<0.0001), but not in older patients (VAS1, 0.91 vs. 0.28; p=0.06; VAS2, 1.52 vs. 0,92; p=0.06). Vagal symptoms were registered in 36 (12%) patients in all groups. Sepsis occurred in one group 1 patient and in one group 2 patient. Rectal bleeding was observed in one group 2 patient.
  
  
  CONCLUSIONS
  Combined prilocaine-lidocaine cream topically placed with PNB is superior to PNB alone and may be of maximum benefit for younger patients.
authors: Istituto Scientifico Ospedale San Raffaele, Università Vita Salute, Cattedra di Urologia, Milan, Italy. marco.raber@fastwebnet.it
authors: Marco
authors: M
authors: Raber
authors: Vincenzo
authors: V
authors: Scattoni
authors: Marco
authors: M
authors: Roscigno
authors: Federico
authors: F
authors: Dehò
authors: Alberto
authors: A
authors: Briganti
authors: Andrea
authors: A
authors: Salonia
authors: Andrea
authors: A
authors: Gallina
authors: Valerio
authors: V
authors: Di Girolamo
authors: Francesco
authors: F
authors: Montorsi
authors: Patrizio
authors: P
authors: Rigatti
mesh_terms: 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*; D005500:Follow-Up Studies; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D009824:Ointments / Q000008:administration & dosage; D010146:Pain / Q000517:prevention & control*; D010147:Pain Measurement; D010525:Peripheral Nerves; D011318:Prilocaine / Q000008:administration & dosage; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D009824:Ointments; D011318:Prilocaine; D008012:Lidocaine