Analgesic Efficacy of Intrarectal Instillation of Lidocaine Gel prior to Transrectal Ultrasound Guided Prostate Biopsy: A Prospective Randomized Trial.

Yun,  Tae Jin; Lee,  Hak Jong; Kim,  Seung Hyup; Lee,  Sang Eun; Byun,  Seok Soo; Cho,  Jeong Yeon; Seong,  Chang Kyu

Journal of Korean Society of Ultrasound in Medicine 2006;25(2): 81-85.

Tae Jin Yun, Hak Jong Lee, Seung Hyup Kim, Sang Eun Lee, Seok Soo Byun, Jeong Yeon Cho, Chang Kyu Seong

¹Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Korea. hakjlee@radiol.snu.ac.kr
²Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Korea.
³Department of Urology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Korea.
⁴Department of Radiology, Seoul National University College of Medicine, Seoul National University Borame Hospital, Korea.

Published online: June 1, 2006.

ABSTRACT

PURPOSE: To assess the analgesic efficacy of intrarectal lidocaine gel instillation prior to periprostatic nerve block during transrectal, ultrasound-guided prostate biopsies. MATERIALS and METHODS: Between March 2004 and October 2004, 203 consecutive patients for prostate biopsies were randomized into two groups. In 90 patients of group A, 10ml of 2% lidocaine gel was instilled intrarectally 10 minutes prior to periprostatic neurovascular bundle block, while 113 patients of group B received only periprostatic neurovascular bundle block without lidocaine gel instillation. Pain was assessed with the visual analogue pain scale, during periprostatic neurovascular bundle block (VAS 1), during the biopsy procedures (VAS 2) and 20 minutes after the procedure (VAS 3). The difference in VAS scores between patients in the two groups was evaluated with the unpaired t-test, with p < 0.05 considered significant. RESULTS: Patients in group A experienced statistically less pain during transrectal ultrasound guided prostate biopsy (VAS 2, 2.994 versus 3.903, p < 0.01). However, no significant difference in VAS values could be demonstrated during periprostatic neurovascular bundle block (VAS 1, 4.761 versus 5.133, p > 0.05) or at after 20 minutes after the procedure (VAS 3, 0.9778 versus 1.257, p > 0.05). CONCLUSION: Intrarectal instillation of lidocaine gel leads to significant additional analgesic efficacy during the biopsy procedure. It is a simple, safe and rapid technique that should be considered in all patients undergoing TRUS guided prostate biopsy.

Keywords: Prostate; Cancer; Ultrasound; Biopsies; Pain; Analgesics