title: Comparison between lidocaine and glyceryl trinitrate ointment for perianal-intrarectal local anesthesia before transrectal ultrasonography-guided prostate biopsy: a placebo-controlled trial.
abstract: OBJECTIVE
  To evaluate the use of topical lidocaine gel and glyceryl trinitrate ointment (GTN) vs placebo, in reducing anal pain and discomfort as an adjunct to periprostatic anesthesia because of probe insertion, during the use of transrectal ultrasonography (TRUS) prostate-guided biopsy in young patients.
  
  
  METHODS
  Two-hundred twenty-three men who underwent prostate biopsy were divided into 3 groups. Seventy-four patients (first group) and 76 patients (second group) received perianal local anesthesia with lidocaine gel 2%, and 1 g of 0.4% GTN ointment, respectively, whereas 73 patients (third group) received lubricant gel as perianal local anesthesia. All patients also underwent periprostatic nerve block (PPNB). Visual analogue scales (VAS 1 and VAS 2) were used to estimate the pain and discomfort during probe insertion and biopsy.
  
  
  RESULTS
  Men in the first and second groups reported significantly less pain score (mean, 1.7 and 1.6, respectively) vs men from the third group (mean, 5.7) during probe insertion. Comparing the 3 different groups subsequently with the periprostatic anesthesia, no significant difference in VAS scores between the first and the third groups (mean, 1.9 and 2.1, respectively) was found; in addition, patients from the second group reported significantly less pain score (mean, 1.3) during biopsy.
  
  
  CONCLUSIONS
  Lidocaine gel and GTN ointment is safe and effective in reducing anal pain associated with the insertion of an ultrasound probe. Furthermore, men with GTN ointment also reported less pain during biopsy. We suggest that analgesia before PPNB could significantly reduce anal pain and improve tolerance during TRUS prostate-guided biopsy.
authors.affiliation: Department of Urology, General Hospital Koutlibanio, Larisa, Greece. kostas.skriapas@hotmail.com
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Skriapas
authors.forename: Charalampos
authors.initials: C
authors.lastname: Konstantinidis
authors.forename: Michael
authors.initials: M
authors.lastname: Samarinas
authors.forename: Stylianos
authors.initials: S
authors.lastname: Xanthis
authors.forename: Aristomenis
authors.initials: A
authors.lastname: Gekas
mesh_terms: D000772:Anesthesia, Local; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001707:Biopsy, Needle; D005782:Gels; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D005996:Nitroglycerin / Q000008:administration & dosage*; D009824:Ointments; D010146:Pain / Q000517:prevention & control; D010147:Pain Measurement; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D012007:Rectum / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional
chemical_list: D000779:Anesthetics, Local; D005782:Gels; D009824:Ointments; D008012:Lidocaine; D005996:Nitroglycerin