[Ultrasound guided transrectal prostatic biopsy and pain. Prospective randomized study comparing lubricant gel, lidocaine gel, and anesthetic blockage of the neurovascular bundles with 1% lidocaine].
OBJECTIVE
To quantify anxiety and immediate and late pain, efficacy of the common analgesic methods, and complications.


METHODS
117 patients were randomized to three groups: 1 (39): lubricant gel; 2 (38): intrarectal lidocaine gel; 3 (40): anesthetic blockage with 1% lidocaine. Complications and immediate and late pain were collected, these latter with a visual analogic scale.


RESULTS
70% of the patients were not much anxious. We did not find significant differences between the analgesia achieved in group 1 (4.37 +/- 2.41) and group 2 (4.22 +/- 2.46), but we found with group 3 (1.88 +/- 2.03). Mean pain score the afternoon after biopsy was lower in group 3 (2.08 +/- 2.28) than in groups 1 and 2 (4.06 +/- 2.80 and 2.42 +/- 2.03), without statistical significance. The patients did not show a difference in pain during the pass of the transrectal transducer, varying between 2.34 for group 3 and 3.38 for group 2. Grouped by sphincter tone we find differences (low 2.71 +/- 2.76, medium 3.23 +/- 2.38, high 4.99 +/- 2.22). Patients feeling very nervous before the test had a pain score of 4.98 +/- 2.57, significantly greater than the pain of those not feeling nervous (2.59 +/- 2.21). We did not find differences in complications between the three groups.


CONCLUSIONS
The use of intrarectal lidocaine gel did not demonstrated being more effective in pain control in our series than the use of lubricant gel, but lidocaine injected into the apex and seminal vesicles was. Sphincter tone and pretest anxiety are the most determinants factors for pain.
Argüelles Salido
Enrique
E
Servicio de Urología, Hospitales Universitarios Virgen del Rocío, Sevilla, España. earguelles@telefonica.net
Congregado Ruiz
Carmen B
CB
Conde Sánchez
José M
JM
Ruiz Zafra
Verónica
V
Medina López
Rafael A
RA
Campoy Martínez
Pedro
P
D000368:Aged; D000779:Anesthetics, Local / Q000627:therapeutic use*; D001706:Biopsy / Q000009:adverse effects / Q000379:methods; D005782:Gels; D006801:Humans; D008012:Lidocaine / Q000627:therapeutic use*; 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*; D011795:Surveys and Questionnaires; D014463:Ultrasonography
D000779:Anesthetics, Local; D005782:Gels; D008012:Lidocaine