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Original Research



A combination of intrarectal lidocaine cream plus periprostatic nerve block improves pain control in transrectal ultrasound guided prostate biopsy: A prospective evaluation

Ekrem Akdeniz, Sevda Akdeniz.




Abstract

Objective: Prostate biopsy is a painful procedure. The aim of this study was to determine which stage of prostate biopsy is most painful and to investigate the effect of intrarectal local anesthetic (IRLA) on the periprostatic nerve block (PNB).
Methodology: Two groups were established in this single-blind prospective, randomized controlled study. One received ultrasonic gel+prilocaine during PNB (Group UP) and the other received a intrarectal lidocaine gel+prilocaine combination (Group IP). Prior to probe insertion, ultrasonic gel only was applied to the patients in Group UP, while the subjects in Group IP were administered 60 mg of lidocaine gel via the rectal route 5 min before the biopsy procedure. In the subsequent stage, 10 cc of 2% prilocaine was infiltrated 4 ml into each prostate-seminal vesicle junction and 2 ml into the apex of the prostate. Pain evaluation during and after biopsy was explained to the patients, and this assessment was performed using a Visual Analog Scale (VAS).
Results: The mean age of the patients was 63.37±6.61 years. We identified probe insertion as the most painful stage of prostate biopsy. The mean visual analog scale (VAS) scores during probe insertion were 3.63±0.98 in Group UP and 3.35±0.85 in Group IP (p=0.001). We observed less pain in patients receiving an IRLA+PNB combination during biopsy (p=0.001).
Conclusions: Probe insertion is the most painful stage in transrectal ultrasonography guided prostate biopsies, and IRLA significantly reduces probe insertion-related pain. In addition, an IRLA+PNB combination causes less pain than ultrasonic gel+PNB during biopsy.

Key words: Intrarectal lidocaine cream; Pain; Prostate; Transrectal biopsy






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