Addition of lidocaine suppositories to periprostatic nerve block enhances pain control in prostate biopsies: a placebo-controlled randomized trial.

Purpose: The aim of this study was to evaluate the efficacy of a combined topical and local anesthesia consisting of a transrectal lidocaine suppository followed by periprostatic nerve block (PNB) in comparison to the combination of transrectally applied lidocaine gel followed by PNB and PNB alone as methods of reducing pain during transrectal prostate biopsy.

Patients And Methods: 100 patients were randomized to four groups and received either a placebo suppository or 10 ml of 2% lidocaine gel or a suppository containing 60 or 120 mg of lidocaine 1 h before biopsy. Additionally, every patient received a PNB using 5 ml 2% lidocaine. After performing an extensive transrectal ultrasound-guided biopsy, pain was evaluated using a visual pain scale.

Results: The mean pain score in the placebo group was 3.4, in the lidocaine gel group it was 3.7, and in the 60 or 120 mg lidocaine suppository groups it was 2.4 and 2.5, respectively. No patient showed vegetative symptoms like sweating or symptomatic hypotonia and no patient had severe pain.

Conclusion: The addition of lidocaine suppositories to PNB as a form of combined anesthesia showed a significantly better pain reduction than the addition of lidocaine gel to PNB or PNB alone.