Comparison of local anesthesia techniques during transrectal ultrasound-guided biopsies.

Objectives: To compare the effectiveness of periprostatic nerve blockade versus intrarectal lidocaine during transrectal ultrasound-guided biopsies.

Methods: A prospective randomized study was performed on 150 men requiring biopsy of the prostate. Patients were assigned to three groups: group 1 received no anesthetic, group 2 received 10 mL of 2% lidocaine gel intrarectally, and group 3 received a periprostatic injection of 5 mL of 1% lidocaine solution before undergoing prostate biopsy. Patients were asked to respond to a preprocedural and postprocedural questionnaire that consisted of four questions designed to evaluate pain perception and pain experienced, respectively, during the entire procedure.

Results: The mean pain scores, comparing responses from groups 2 (topical lidocaine) and 3 (periprostatic) individually with those from group 1 (control), were not statistically different for any of the preprocedural questions. The postprocedural pain scores were significantly lower in groups 2 and 3 compared with those from group 1 (control) for overall procedure impression (3.1 +/- 1.7 and 2.6 +/- 1.8 versus 3.8 +/- 1.8, respectively; P <0.05 for both). The postprocedural scores for probe insertion were significantly lower for the topical group than for the control group (2.2 +/- 1.7 versus 3.7 +/- 2.1, P <0.05) but not for the periprostatic group compared with the control group (3.0 +/- 1.9, P = 0.14). The biopsy postprocedural scores were significantly lower for the periprostatic group than for the control group (2.8 +/- 1.9 versus 4.3 +/- 1.7, P <0.05).

Conclusions: Our data confirm that both techniques of local anesthesia are effective in reducing patient discomfort; however, periprostatic nerve blockade using injectable lidocaine appears to be more specific in reducing pain during the biopsy portion of the procedure.