title: Combination of Tramadol and Lidocaine for Pain Control During Transrectal Ultrasound-guided Prostate Biopsy: A Randomized Double-blinded Study.
abstract: OBJECTIVE
  To evaluate the efficacy of tramadol, lidocaine, and a combination of tramadol with lidocaine in pain relief using periprostatic nerve block technique by guidance of transrectal ultrasound (TRUS) before the prostate biopsy (PBx).
  
  
  METHODS
  For the indication of TRUS-PBx, the patients with a prostate-specific antigen (PSA) level >4.0 ng/mL or abnormal digital examination findings were selected. The patients were randomized through random method. Group 1: patients were administered 5 mL of 2% lidocaine; group 2: patients were administered 5 mL of 25-mg tramadol; and group 3: patients were administered 5 mL of 2% lidocaine + 25-mg tramadol. The procedures were completed in 10 minutes, and a visual pain scale was administered to the patients to question the pain severity.
  
  
  RESULTS
  TRUS-guided PBx was performed in 60 patients with an age range of 57-77 years (mean age, 66.2 ± 7.49 years) and a PSA range of 1-1000 ng/mL. The mean PSA level of the groups was 28.5 (±7.5), 16.1 (±5.0), and 14.9 (±2.9) ng/mL, respectively. The postprocedural pain scores by visual pain scale were 4.6 ± 1.2, 5.4 ± 1.2, and 3.6 ± 0.9 in lidocaine, tramadol, and lidocaine + tramadol groups, respectively.
  
  
  CONCLUSIONS
  Periprostatic nerve block is the current golden standard method owing to pain management and comfort provided, independent of the patient age and the number of core biopsies. We suggest that tramadol may also be used in this field to achieve better pain management by improving lidocaine's effect or as an alternative to lidocaine.
authors.affiliation: Department of Urology, University of Gaziantep, School of Medicine, Gaziantep, Turkey. Electronic address: drhaluksen@gmail.com.
authors.forename: Haluk
authors.initials: H
authors.lastname: Sen
authors.affiliation: Department of Urology, University of Gaziantep, School of Medicine, Gaziantep, Turkey.
authors.forename: Ilker
authors.initials: I
authors.lastname: Seckiner
authors.affiliation: Department of Urology, University of Gaziantep, School of Medicine, Gaziantep, Turkey.
authors.forename: Omer
authors.initials: O
authors.lastname: Bayrak
authors.affiliation: Department of Anesthesiology and Reanimation, University of Gaziantep, School of Medicine, Gaziantep, Turkey.
authors.forename: Elzem
authors.initials: E
authors.lastname: Sen
authors.affiliation: Department of Urology, University of Gaziantep, School of Medicine, Gaziantep, Turkey.
authors.forename: Sakip
authors.initials: S
authors.lastname: Erturhan
authors.affiliation: Department of Urology, University of Gaziantep, School of Medicine, Gaziantep, Turkey.
authors.forename: Faruk
authors.initials: F
authors.lastname: Yagci
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001707:Biopsy, Needle / Q000009:adverse effects / Q000379:methods; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D006801:Humans; D061705:Image-Guided Biopsy / Q000009:adverse effects; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000517:prevention & control*; D059408:Pain Management; D011446:Prospective Studies; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology*; D014147:Tramadol / Q000008:administration & dosage*; D018084:Ultrasonography, Interventional
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D014147:Tramadol; D008012:Lidocaine