title: Combined perianal-intrarectal (PI) lidocaine-prilocaine (LP) cream and lidocaine-ketorolac gel provide better pain relief than combined PI LP cream and periprostatic nerve block during transrectal prostate biopsy.
abstract: What's known on the subject? and What does the study add? Study Type - Harm Reduction RCT Level of Evidence 1b The combination of perianal-intrarectal lidocaine-prilocaine cream and periprostatic nerve block effectively counteracts probe and sampling related pain during transrectal prostate biopsy, but not pain due to periprostatic infiltration. The novel combination of lidocaine-prilocaine cream and lidocaine-ketorolac gel, both administered perianal-intrarectally, provides the same probe and sampling-related pain relief than combined perianal-intrarectal lidocaine-prilocaine cream and periprostatic nerve block and prevents the non-negligible pain due to periprostatic infiltration, thus leading to better overall patients' compliance to the procedure.
  
  
  OBJECTIVE
  • To compare the efficacy and safety of combined perianal-intrarectal (PI) lidocaine-prilocaine (LP) cream and lidocaine-ketorolac (LK) gel with combined PI LP cream and periprostatic nerve block (PPNB) in relieving pain during transrectal ultrasonography guided prostate biopsy (TPB).
  
  
  METHODS
  • In all, 200 patients were randomized to receive combined PI LP cream and LK gel (group 1) or combined PI LP cream and PPNB (group 2) before TPB. • The 0-10-point visual analogue scale (VAS) was used for assessing pain at probe insertion and movements (VAS-1), periprostatic infiltration (VAS-2) when applied, and prostate sampling (VAS-3), as well as maximal procedural pain (MPP). • Complications occurring ≤ 20 days after the TPB were recorded.
  
  
  RESULTS
  • The groups were comparable for patients' age, serum PSA level, prostate volume, and cancer detection rate. • All patients tolerated the procedure well. The two anaesthetic regimens provided almost equal mean VAS-1 (0.33 vs 0.37; P= 0.701) and VAS-3 (0.52 vs 0.51; P= 0.954) scores, but patients in group 2 reported significantly greater MPP scores (0.68 vs 1.53; P < 0.001) as periprostatic infiltration was the most painful part of the procedure (mean VAS-2: 1.33). • Complications rate was similar in the two groups (1% vs 2%; P= 0.38).
  
  
  CONCLUSIONS
  • The novel combination of PI LP cream and LK gel provided the same probe- and sampling- related pain relief as combined PI LP and PPNB; moreover, by preventing the non-negligible periprostatic infiltration pain, it provided significantly better overall patients' compliance to the procedure. • Being safe and easy to administer, this novel non-infiltrative regimen has the potential to replace infiltrative anaesthesia in relieving pain during TPB.
authors: Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy. luigicormio@libero.it
authors: Luigi
authors: L
authors: Cormio
authors: Vincenzo
authors: V
authors: Pagliarulo
authors: Fabrizio
authors: F
authors: Lorusso
authors: Oscar
authors: O
authors: Selvaggio
authors: Antonia
authors: A
authors: Perrone
authors: Francesca
authors: F
authors: Sanguedolce
authors: Pantaleo
authors: P
authors: Bufo
authors: Giuseppe
authors: G
authors: Carrieri
mesh_terms: D000285:Administration, Rectal; D000368:Aged; D019162:Anesthetics, Combined / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001706:Biopsy / Q000379:methods; D016861:Cyclooxygenase Inhibitors / Q000008:administration & dosage; D004643:Emollients; D005782:Gels; D006801:Humans; D020910:Ketorolac / Q000008:administration & dosage; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010146:Pain / Q000517:prevention & control*; D010147:Pain Measurement; D011318:Prilocaine / Q000008:administration & dosage; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000473:pathology*
chemical_list: D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D016861:Cyclooxygenase Inhibitors; D004643:Emollients; D005782:Gels; D011318:Prilocaine; D008012:Lidocaine; D020910:Ketorolac