Periprostatic nerve block (PNB) alone vs PNB combined with an anaesthetic-myorelaxant agent cream for prostate biopsy: a prospective, randomized double-arm study

Abstract

Objective: To compare the efficacy of periprostatic nerve block (PNB) alone vs PNB combined with the local administration of a 1.5% lidocaine/0.3% nifedipine cream (Antrolin, Bracco, Milan, Italy).

Patients and methods: In a prospective, randomized, double-arm study, 200 patients were randomized to receive PNB alone (group A, 100) or PNB combined with a previous administration of the topical anaesthetic Antrolin (group B, 100). The PNB was applied by infiltrating bilaterally a solution of 5 mL lidocaine 1% and naropine 0.75%. Patients were asked to complete visual analogue scale (VAS) questionnaire (0-10) to score pain and discomfort during probe insertion (VAS1), PNB (VAS2), cores (VAS3), 30 min after biopsy (VAS4), the evening of the procedure (VAS5), and the day after biopsy (VAS6).

Results: Pain during probe insertion in group B was significantly less than in group A (VAS1 0.82 vs 2.9; P < 0.001). Pain during periprostatic infiltration was also lower in group B than group A (VAS2 1.4 vs 3.48; P < 0.001). Pain control was similar during biopsy in the two groups (VAS3 1.28 vs 1.2; P = 0.69). The pain scored at VAS4 was significantly less in group B (0.7 vs 1.86, P < 0.001), as was VAS5 (0.68 vs 1.3, P < 0.001). There was no difference in pain perception the day after biopsy (VAS6, 0.32 vs 0.22, P = 0.14).

Conclusions: Antrolin placed with PNB is better than PNB alone in reducing pain and discomfort during transrectal-ultrasonography guided prostate biopsy.