[Local anesthesia in transrectal ultrasound-guided prostate biopsy: apical periprostatic nerve block versus endorectal lidocaine gel. A randomized controlled trial of 100 patients].

Background: Intrarectal lidocaine application and apical periprostatic nerve block are a safe technique that significantly reduces pain during transrectal prostate biopsy.

Aim: We compare prospectively the effectiveness of intrarectal lidocaine gel versus periprostatic lidocaine injection during transrectal ultrasound -guided prostate biopsy.

Methods: From June 2005 to February 2006, 100 consecutive patients underwent prostatic biopsies. Patients were randomized to receive 10 cc of 2% lidocaine gel in endorectally (Group I), 10 cc of 1% lidocaine solution injected into the prostate apex to induce bilateral periprostatic nerve block (Group II), or intrarectal 10 cc of ultrasound gel as placebo (Groupe III). Pain was evaluated by a 10-point linear visual analogue pain scale (VAS), and a 5-point digital visual scale (DVS). The side effects of the drugs and complications were also evaluated.

Results: The three groups counted respectively: 33, 33 and 34 patients and were statically comparable as the age, prostate volume, PSA level and the number of biopsies. The mean pain score on the VAS was respectively 4,1;4,6 and 3,5 for the three groups. The DVS score was 2,5; 2,8 and 2,15 (p < 0.001). Pain scores were significantly lower in Group 3 and equivalent between Groups 1 and 2. There is no difference in complication rate between the three groups.

Conclusion: Compared to intrarectal lidocaine application, apical periprostatic nerve block is a safe technique that significantly reduces pain during transrectal prostate biopsy, with no increase in the complication rate.