title: Comparison of two periprostatic nerve blockade techniques for transrectal ultrasound-guided prostate biopsy: bilateral basal injection and single apical injection.
abstract: OBJECTIVE
  To investigate the effectiveness of a periprostatic nerve blockade technique that relies on a single apical injection of lidocaine. We compared it with bilateral injections at the base of the prostate to determine the effectiveness of pain control and to compare the technical aspects during transrectal ultrasound-guided prostate biopsy.
  
  
  METHODS
  The study included patients who had elected to undergo transrectal ultrasound-guided prostate needle biopsy. The patients were divided into 2 groups according to the anesthesia technique they would receive. In the bilateral basal injection group (n = 60), 2 injections of 5 mL lidocaine were administered just lateral to the junction between the base of the prostate and the seminal vesicles on both sides. In the single apical injection group (n = 57) 5 mL of lidocaine was injected at the apex of the prostate to provide the distribution of lidocaine toward the base of the prostate under Denonvilliers fascia.
  
  
  RESULTS
  Both techniques were effective regarding pain control, with better results in the single apical injection group. The mean numeric rating scale score was 2.46 +/- 1.03 and 2.01 +/- 1.02 in the bilateral basal injection and single apical injection groups, respectively (P = .01).
  
  
  CONCLUSIONS
  The results of this randomized prospective study suggest that both the single apical injection and the bilateral basal injection techniques are effective in terms of pain prevention during transrectal-ultrasound-guided prostate biopsy. The main advantage of the single apical injection technique is its ease of use and the requirement for one half the amount of local anesthetic agent.
authors.affiliation: Department of Urology, Bayindir Hospital, Ankara, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Akan
authors.forename: Ozdal
authors.initials: O
authors.lastname: Yildiz
authors.forename: Izak
authors.initials: I
authors.lastname: Dalva
authors.forename: Cüneyt
authors.initials: C
authors.lastname: Yücesoy
mesh_terms: D000779:Anesthetics, Local / Q000008:administration & dosage*; D001707:Biopsy, Needle / Q000379:methods; D006801:Humans; D007267:Injections; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D011446:Prospective Studies; D011467:Prostate / Q000000981:diagnostic imaging* / Q000294:innervation / Q000473:pathology*; D014463:Ultrasonography
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine