title: A prospective randomized trial comparing three different analgesic techniques for pain control during transrectal ultrasound guided prostate biopsy: a single center experience.
abstract: OBJECTIVE
  The aim of this paper was to optimize pain control during transrectal ultrasound (TRUS) guided prostate biopsy, the efficacy and safety of three different analgesic techniques were compared.
  
  
  METHODS
  Two hundred and forty patients were prospectively randomized into 3 groups before TRUS guided prostate biopsy. Group A received combined periprostatic nerve block (PPNB) and perianal-intrarectal lidocaine-prilocaine (PILP) cream; group B: PILP cream; group C: PPNB. Pain was evaluated using 10-point Visual Analog Scale (VAS).
  
  
  RESULTS
  VAS during TRUS was lower in groups A and B vs. C (mean 1.3,1.4 vs. 5.1, P<0.001); VAS for PPNB was lower in group A and group B vs. C (mean 1.1,1.3 vs. 3.5, P<0.001). VAS for sampling wase lower in group A as compared to B and C (mean 0.6, 3.5 and 1.4, P<0.001). VAS on stratified analysis was significantly lower in groupA vs. B and C in patients <60 years, prostate >50 cc and those with lower anorectal compliance (P<0.001). The overall complication rate was similar in all three groups.
  
  
  CONCLUSIONS
  The combination of PILP and PPNB provides better analgesia, especially in patients <60 years, prostate volume >50 cc and lower anorectal compliance as compared to two modalities used alone during the sampling part of TRUS guided prostate biopsy with no increase in the complication rate.
authors.affiliation: Department of Urology, V.M. Medical College and Safdarjang Hospital, New Delhi, India. anup_14k@yahoo.com
authors.forename: K
authors.initials: K
authors.lastname: Anup
authors.forename: V
authors.initials: V
authors.lastname: Pawan
authors.forename: K
authors.initials: K
authors.lastname: Niraj
authors.forename: N
authors.initials: N
authors.lastname: Biswajit
authors.forename: M K
authors.initials: MK
authors.lastname: Nayan
mesh_terms: D000285:Administration, Rectal; D000368:Aged; D000698:Analgesia / Q000379:methods*; D019162:Anesthetics, Combined / Q000008:administration & dosage / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D001707:Biopsy, Needle / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007267:Injections; D008012:Lidocaine / Q000008:administration & dosage; D000077442:Lidocaine, Prilocaine Drug Combination; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D009824:Ointments; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D011318:Prilocaine / Q000008:administration & dosage; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D018084:Ultrasonography, Interventional; D014552:Urinary Tract Infections / Q000209:etiology
chemical_list: D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D000077442:Lidocaine, Prilocaine Drug Combination; D009824:Ointments; D011318:Prilocaine; D008012:Lidocaine