Intraprostatic local anesthesia with periprostatic nerve block for transrectal ultrasound guided prostate biopsy

Abstract

Purpose: Prostate biopsy is an invasive procedure that may be painful and require some form of anesthesia. We compared the pain control results of periprostatic nerve block alone vs periprostatic nerve block with intraprostatic anesthesia as local anesthesia for prostate biopsy.

Materials and methods: A total of 300 patients who underwent transrectal ultrasound guided prostate biopsy were randomized into 3 groups. Group 1 of 100 patients received periprostatic nerve block and intraprostatic local anesthesia with 5 ml 2% lidocaine. Group 2 of 100 patients received periprostatic nerve block and the same amount of 0.9% NaCl by intraprostatic injection. Group 3 of 100 patients received no anesthesia. Patients were asked to use a scale of 0 to 10 to complete a visual analog scale questionnaire about pain during probe insertion, anesthesia and biopsy.

Results: Pain control was similar during probe insertion and anesthesia in the 3 groups (p = 0.885 and 0.227, respectively). Pain during biopsy in group 1 was significantly less than in groups 2 and 3 (p <0.0001). In patients with a smaller prostate volume (48 ml or less) these differences were still significant between group 1 and 2 (p <0.0001), although not in patients with a larger prostate volume (greater than 48 ml) (p = 0.185). In patients 66 years old or younger these differences were also significant in groups 1 and 2 (p <0.0001) but not in older patients (p = 0.155).

Conclusions: Combining periprostatic nerve block and intraprostatic local anesthesia provided significantly better pain control than periprostatic nerve block alone. The combination may be of maximum benefit in patients with a smaller prostate volume or younger patients.