title: Comparison of two different doses of lidocaine on the pain sensation during transrectal ultrasound-guided prostate biopsy.
abstract: OBJECTIVE
  To compare two different doses of lidocaine used for periprostatic nerve block on pain perception during transrectal ultrasound (TRUS) guided prostate biopsy.
  
  
  METHODS
  A total of 288 patients with elevated prostate specific antigen (PSA) levels and/or abnormal digital rectal examination who underwent TRUS-guided prostate biopsy were included in the study. The patients were divided into 3 groups: Group 1 (n=103) prostate biopsy were performed after administering perianal intrarectal application of 10 mL 2% lidocaine gel, Group 2 (n=98) 2 mL of 2% lidocaine injection on each side following rectal installation of lidocaine gel and Group 3 (n=87) 4 mL of 2% lidocaine injection on each side after rectal instillation of lidocaine gel. Patients' pain scores during biopsy procedure were reported using visual analogue score (VAS). Independent sample t test, ANOVA test and Tukey test were used for statistical evaluation.
  
  
  RESULTS
  The mean age, prostate volume and PSA level were 65.6±8.4 years, 58.2±34.8 mL, and 11.8±3.4 ng/mL respectively. There were no statistically significant differences in baseline characteristics between the groups. The mean VAS scores were 2.4±1.8 in Group 1, 2.5±1.9 in Group 2 and 1.6±1.6 in Group 3. Patients in Group 3, reported significant pain reduction compared with patients in Groups 1 and 2 (p=0.002, and 0.001, respectively). However, there was no statistically significant difference in VAS scores between Groups 1 and 2 (p=0.815).
  
  
  CONCLUSIONS
  According to our results we recommend the use of perianal intrarectal lidocain gel application, and periprostatic nerve block with injection of 4 ml 2% lidocaine per side combination in TRUS-guided prostate biopsies. Further large-scale randomized control studies are needed to validate these finding.
authors.affiliation: Department of Urology, Gülhane Military Medical Academy Haydarpaşa Training Hospital, İstanbul, Turkey.
authors.forename: Ferhat
authors.initials: F
authors.lastname: Ateş
authors.affiliation: Department of Urology, Gümüşsuyu Military Hospital, İstanbul, Turkey.
authors.forename: Furkan
authors.initials: F
authors.lastname: Dursun
authors.affiliation: Department of Urology, Gülhane Military Medical Academy Haydarpaşa Training Hospital, İstanbul, Turkey.
authors.forename: Ercan
authors.initials: E
authors.lastname: Malkoç
authors.affiliation: Department of Urology, Gülhane Military Medical Academy Haydarpaşa Training Hospital, İstanbul, Turkey.
authors.forename: Ömer
authors.initials: Ö
authors.lastname: Yılmaz
authors.affiliation: Department of Urology, Gülhane Military Medical Academy Haydarpaşa Training Hospital, İstanbul, Turkey.
authors.forename: Hasan
authors.initials: H
authors.lastname: Soydan
authors.affiliation: Department of Anesthesia, Gülhane Military Medical Academy Haydarpaşa Training Hospital, İstanbul, Turkey.
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Şen
authors.affiliation: Department of Urology, Gülhane Military Medical Academy Haydarpaşa Training Hospital, İstanbul, Turkey.
authors.forename: Şeref
authors.initials: Ş
authors.lastname: Başal
authors.affiliation: Department of Urology, Hakkari Military Hospital, Hakkari, Turkey.
authors.forename: Fatih
authors.initials: F
authors.lastname: Zekey
authors.affiliation: Department of Urology, Gülhane Military Medical Academy Haydarpaşa Training Hospital, İstanbul, Turkey.
authors.forename: Kenan
authors.initials: K
authors.lastname: Karademir
keywords: Lidocaine dose; perianal intrarectal lidocaine; periprostatic nerve block; prostate biopsy; visual analog score