Periprostatic local anesthesia in transrectal ultrasound-guided prostate biopsy: is it possible to improve pain tolerance?

Abstract

Objective: Evaluate objectively pain tolerance in transrectal ultrasound-guided prostate biopsy (TRUS) using local periprostatic anesthesia applied intrarectally, compared to the conventional method.

Material and methods: Forty patients were submitted to TRUS-guided prostate biopsy due to clinical suspicious of neoplasia. Patients were randomized in 2 groups: group-I, with 20 patients submitted to local anesthesia by 4 periprostatic injection of 2.5 mL 1% lidocaine, without epinephrine, TRUS-guided; and group-II, with 20 controls, with no sedatives or analgesia. After biopsy, patients were questioned about pain intensity during the procedure, using a grading scale from 0 to 5, correlating numbers, colors, and pain intensity. Pain related to probe manipulation or biopsy punctures, acceptance of an eventual re-biopsy, side effects of the drug used, and later complications of the procedure were also evaluated.

Results: Both groups were consistent comparing PSA levels, and prostate volume. As for pain intensity, 18/20 patients had severe or intolerable pain on the group submitted to conventional biopsy, while for those submitted to periprostatic blockage this event occurred in 3/20 patients (Chi(2 ) =22.50; p<0.01). The most important pain component was manipulation of the transrectal probe in 28% of patients, and puncture itself in 72%. Acceptance of re-biopsy as a pain evaluation criterion occurred in only 45% of patients submitted to conventional biopsy, compared to 100% of those submitted to periprostatic anesthesia (Chi (2)=15.17; p<0.01).

Conclusion: TRUS-guided prostate biopsy is a traumatic and painful experience, but the periprostatic blockage use is clearly associated with more tolerance and patient comfort during the exam.