Topical and long-acting local anesthetic for prostate biopsy: a prospective randomized placebo-controlled study.
OBJECTIVE
To determine the efficacy of intrarectal lidocaine gel alone and a combination of lidocaine gel with 2 different longer-acting local anesthetic (LA) agents that were injected into the periprostatic area before transrectal ultrasound-guided prostate biopsy.


METHODS
One hundred patients undergoing transrectal prostate biopsy were randomized into 4 groups of 25 patients each. Before the biopsy, group 1 received no local anesthesia, group 2 received 2% lidocaine gel intrarectally, group 3 received intrarectal lidocaine gel and 5 ml bupivacaine (0.25%) injected into periprostatic area, and group 4 received lidocaine gel intrarectally and a 5-ml ropivacaine injection (0.25%) in the same location as group 3. Pain levels during and after the biopsy were assessed by using a 10-point linear visual analog scale (VAS).


RESULTS
Patients in groups 3 and 4 had significantly lower VAS scores than those in groups 1 and 2, both during and 1 h after biopsy. There were no differences in the pain scores between groups 1 and 2.


CONCLUSIONS
The combination of intrarectal lidocaine gel and periprostatic longer-acting LA agents significantly reduces the pain related to prostate biopsy, whereas intrarectal lidocaine gel administration alone does not reduce pain. Thus, administration of the periprostatic longer-acting LA agents alone is adequate.
Yurdakul
Talat
T
Department of Urology, Meram Medical Faculty, Selcuk University, Meram, Turkey.
Taspinar
Bulent
B
Kilic
Ozcan
O
Kilinc
Mehmet
M
Serarslan
Alparslan
A
D000285:Administration, Rectal; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001706:Biopsy / Q000009:adverse effects; D002045:Bupivacaine / Q000008:administration & dosage*; D005782:Gels; D006801:Humans; D007267:Injections; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology* / Q000517:prevention & control*; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*
D000779:Anesthetics, Local; D005782:Gels; D008012:Lidocaine; D002045:Bupivacaine