title: Effect of Oral Administration of Acetaminophen and Topical Application of EMLA on Pain during Transrectal Ultrasound-Guided Prostate Biopsy.
abstract: OBJECTIVE
  Transrectal ultrasound-guided prostate biopsy is the procedure of choice for diagnosing prostate cancer. We compared with pain-relieving effect of acetaminophen, a known drug for enhancing the pain-relieving effect of tramadol, and eutectic mixture of local anesthetics (EMLA), a local anesthetic agent, with that of the conventional periprostatic nerve block method.
  
  
  METHODS
  This was a prospective, randomized, single-blinded study. A total of 430 patients were randomly assigned to three groups. Group 1 received a periprostatic nerve block with 1% lidocaine, group 2 received acetaminophen 650 mg, and group 3 received EMLA cream for pain control. All patients were given 50 mg of tramadol intravenously 30 minutes before the procedure. At 3 hours after completion of the procedure, the patients were asked to grade their pain on a horizontal visual analogue scale (VAS). The patients were also asked whether they were willing to undergo future biopsy if required.
  
  
  RESULTS
  There were no significant differences between the three groups in terms of age, prostate-specific antigen, prostate size, or numbers of biopsy cores. The pain scores for groups 2 and group 3, which were 3.47±1.92 and 3.50±1.36, respectively, were similar and were significantly lower than that of group 1, which was 5.24±2.07.
  
  
  CONCLUSIONS
  Acetaminophen and EMLA cream with intravenous injection of tramadol are safe, easy, and effective methods of controlling pain during the procedure. These methods were more effective for pain relief than was the conventional periprostatic nerve block method.
authors.affiliation: Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Seol
authors.initials: S
authors.lastname: Kim
authors.forename: Byung Il
authors.initials: BI
authors.lastname: Yoon
authors.forename: Su Jin
authors.initials: SJ
authors.lastname: Kim
authors.forename: Hyuk Jin
authors.initials: HJ
authors.lastname: Cho
authors.forename: Hyo Sin
authors.initials: HS
authors.lastname: Kim
authors.forename: Sung Hoo
authors.initials: SH
authors.lastname: Hong
authors.forename: Ji Youl
authors.initials: JY
authors.lastname: Lee
authors.forename: Tae-Kon
authors.initials: TK
authors.lastname: Hwang
authors.forename: Sae Woong
authors.initials: SW
authors.lastname: Kim