Prospective, Double Blind, Clinical Trial of Local Anesthesia for Transrectal Ultrasound Guided Biopsy: Periprostatic vs Intraprostatic Lidocaine Injection

Prospective, Double Blind, Clinical Trial of Local Anesthesia for Transrectal Ultrasound Guided Biopsy: Periprostatic vs Intraprostatic Lidocaine Injection
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Title:Prospective, Double Blind, Clinical Trial of Local Anesthesia for Transrectal Ultrasound Guided Biopsy: Periprostatic vs Intraprostatic Lidocaine Injection
Author/Abstract:Aldrin Joseph R. Gamboa, MD; John Paul Rosales, MD; Louis Lane Gutierrez, MD; John Kenneth Domingo, MD; Carlo C. Bisnar, MD; Jerry H. Santos, MD and Dennis G. Lusaya, MD


Section of Urology, Department of Surgery, University of Santo Tomas Hospital


Transrectal ultrasound guided prostate biopsy has become the gold standard for diagnosing prostate cancer. Considered a well-tolerated minor procedure, about 65% to 90% of men report discomfort. With the goal of decreasing the discomfort, several methods of local anesthesia has been described. Objective: To evaluate the effectiveness of a new method of local anesthesia, namely intraprostatic anesthesia and compared it with periprostatic injection in decreasing the discomfort caused by transrectal ultrasound guided biopsy of the prostate, 12 core protocol. Materials and Methods: From January 2004 to September 2005, fifty five men underwent prostate biopsy at a tertiary hospital. Patients were distributed into 2 groups (periprostatic injection and intraprostatic injection). A visual analog scale was used to assess the pain score. The t-test was performed on all epidemiologic data. Statistical analysis used was Mann Whitney rank test for the pain scores. Chi square was used for the dependence of pain intensity. Results: Fifty five men underwent ultrasound guided prostate biopsy. There were no statistical differences as to age, PSA level and prostate volume between the 2 groups. There was statistical difference in the pain scores of patients after periprostatic injection and intraprostatic injection (2.057 versus 3.750, p 0.0461); and a highly significant difference on the dependence of pain intensity after the mode of injection of local anesthesia (p = 0.0005). Conclusions: Periprostatic lidocaine injection is more effective in alleviating pain associated with prostate biopsy than intraprostatic lidocaine injection, as seen in the lower pain scores. It must be noted that a critical factor for good pain control is the method of anesthetic delivery. Due to its effectivity, routine use of periprostatic lidocaine injection is highly recommended in future biopsies.

Key words: prostate biopsy, pain scores, lidocaine anesthesia
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