title: Pain level and anal discomfort during transrectal ultrasound for guided prostate biopsy. Does intrarectal administration of local anesthetic before periprostatic anesthesia makes any difference?
abstract: OBJECTIVE
  The aim of this study was to evaluate the anal discomfort and pain level, during transrectal ultrasound probe insertion and before the periprostatic anesthesia in young patients (<65 years of age).
  
  
  METHODS
  This study enrolled 147 patients, who underwent prostate biopsy and were divided in two groups: 74 patients received perianal local anesthesia with lidocaine cream 2% (first group), while 73 received only lubricant gel as perianal local anesthesia (second group) prior the insertion of ultrasound probe. Patients in both groups received periprostatic anesthesia. Pain and discomfort due to the probe and due to the biopsy were estimated with visual analogue scale. Patients' characteristics, complications, and surgical data were analyzed for both groups.
  
  
  RESULTS
  No serious intraoperative and postoperative complications were noted in both groups. The mean pain score for pain and anal discomfort was 1.7 and 5.7 for the first and second group, respectively. During biopsy, patients in the first group reported also less pain but there was no significant difference.
  
  
  CONCLUSIONS
  The intrarectal introduction of lidocaine cream 2% can significantly reduce anal discomfort and pain before the probe insertion for ultrasound guided biopsies in young patients. Considering that these patients could undergo repeated biopsies, a higher level of local anesthesia is desired.
authors.affiliation: Department of Urology, Northwest Hospital Stiftung zum Heiligen Geist, Frankfurt am Main, Germany. kostas.skriapas@hotmail.com
authors.forename: K
authors.initials: K
authors.lastname: Skriapas
authors.forename: C
authors.initials: C
authors.lastname: Konstandinidis
authors.forename: M
authors.initials: M
authors.lastname: Samarinas
authors.forename: P
authors.initials: P
authors.lastname: Kartsaklis
authors.forename: A
authors.initials: A
authors.lastname: Gekas
mesh_terms: D000285:Administration, Rectal; D000368:Aged; D000772:Anesthesia, Local / Q000009:adverse effects / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D001004:Anus Diseases / Q000517:prevention & control; D001706:Biopsy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009824:Ointments; D010146:Pain / Q000517:prevention & control*; D010147:Pain Measurement; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography; D036761:Ultrasound, High-Intensity Focused, Transrectal / Q000009:adverse effects
chemical_list: D000779:Anesthetics, Local; D009824:Ointments; D008012:Lidocaine