title: Intrarectal Lidocaine-Diltiazem-Meperidine Gel for Transrectal Ultrasound Guided Prostate Biopsy.
abstract: BACKGROUND
  TRUS-guided needle biopsy of the prostate gland is the current standard method used for diagnosis of prostate cancer. Pain control during this procedure is through the use of i.v. sedation or local anaesthetic (LA), depending on clinician preference.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the effectiveness of intrarectal lidocaine, lidocaine-diltiazem and lidocaine-meperidine-diltiazem gel for anesthetizing transrectal ultrasound guided prostate biopsy.
  
  
  METHODS
  In a randomized double-blind clinical trial, 100 consecutive patients were divided into three groups. The patients received one of the gels before transrectal ultrasound guided prostate needle biopsy: group A, intrarectal and perianal lidocaine, gel 1 g; group B, intrarectal lidocaine gel, 1 g, + perianal diltiazem, 1 g; group C, intrarectal lidocaine gel, 1 g, + meperidine, 25 mg, and perianal diltiazem, 1 g. Visual analog pain scale was used to estimate pain during probe insertion and biopsy. Heart rate and blood pressure during probe insertion and biopsy were recorded too.
  
  
  RESULTS
  The mean of visual analog pain scale was 4.5 in group A, 3.5 in group B, and 2.0 in group C during probe insertion (P value = 0.01). The mean of visual analog pain scale was 5.1 in group A, 3.5 group B, and 2.5 in group C during biopsy (P value = 0.001). The groups were comparable for patients' age, weight, serum prostate-specific antigen (PSA), and prostate size (P > 0.05). No side effects of meperidine and lidocaine including drowsiness, dizziness, tinnitus and light-headedness or requiring assistance for activity were noted.
  
  
  CONCLUSIONS
  Lidocaine-meperidine-diltiazem gel provides significantly better pain control than lidocaine-diltiazem gel and lidocaine gel alone during transrectal ultrasound guided prostate biopsy and probe insertion. This mixture gel is safe, easy to administer and well accepted by patients.
authors.affiliation: Department of Anesthesia, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Farsad
authors.initials: F
authors.lastname: Imani
authors.affiliation: Department of Anesthesia, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Yasaman
authors.initials: Y
authors.lastname: Moghaddam
authors.affiliation: Department of Anesthesia, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Reza
authors.initials: R
authors.lastname: Shariat Moharari
authors.affiliation: Department of Anesthesia, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Farhad
authors.initials: F
authors.lastname: Etezadi
authors.affiliation: Department of Anesthesia, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Khajavi
authors.affiliation: Department of Urology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Seyed Reza
authors.initials: SR
authors.lastname: Hosseini
keywords: Benign Prostatic Hyperplasia; Pain