title: Combination of lidocaine suppository and periprostatic nerve block during transrectal prostate biopsy: a prospective randomized trial.
abstract: OBJECTIVE
  To assess the most effective local analgesia during transrectal ultrasound-guided prostate biopsy.
  
  
  METHODS
  A total of 123 consecutive patients undergoing transrectal ultrasound-guided prostate biopsy for elevated prostate-specific antigen levels and/or a suspicious digital rectal examination were randomized to three groups. Patients received a 60-mg lidocaine suppository (group 1, n = 41), a periprostatic nerve block (10-mL injection of lidocaine hydrochloride; group 2, n = 41) or a combination of both (group 3, n = 41) before a 10-core transrectal ultrasound-guided biopsy. A total of 80.5% (n = 99) of the patients underwent their first biopsy, 27.1% (n = 22) their second and 2.4% (n = 2) the third. Pain was evaluated on a 10-point visual analog scale for each step of the procedure.
  
  
  RESULTS
  Prostate-specific antigen values ranged from 0.39 to 90.1 (mean [SD] 8.76 ng/mL [11.08 ng/mL]). Comparison of the median visual analog scale scores between groups 1 and 2 showed a significant difference (P = 0.004). The differences in the outcomes between groups 1 and 3 (P = 0.001), and groups 2 and 3 (P = 0.001) were also significant. Patients of group 3 had the best output corresponding to the pain sensations and therefore the lowest visual analog scale scores.
  
  
  CONCLUSIONS
  The combination of lidocaine suppository and periprostatic lidocaine infiltration is more effective for pain control than either lidocaine suppository or periprostatic lidocaine infiltration alone in patients undergoing transrectal ultrasound-guided prostate biopsy.
authors: Department of Urology, Hanusch Krankenhaus, Vienna, Austria.
authors: Andreas
authors: A
authors: Lunacek
authors: Christof
authors: C
authors: Mrstik
authors: Josef
authors: J
authors: Simon
authors: Ferdinand
authors: F
authors: Frauscher
authors: Christian
authors: C
authors: Schwentner
authors: Christian
authors: C
authors: Radmayr
authors: Wolfgang
authors: W
authors: Horninger
authors: Eugen
authors: E
authors: Plas
mesh_terms: D000285:Administration, Rectal; D000368:Aged; D000779:Anesthetics, Local; D001706:Biopsy; D006801:Humans; D008012:Lidocaine; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D012007:Rectum / Q000601:surgery*
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine
keywords: biopsy; cancer; detection; local anesthetic; prostate