Combination of lidocaine suppository and periprostatic nerve block during transrectal prostate biopsy: A prospective randomized trial

Lunacek, Andreas; Mrstik, Christof; Simon, J; Frauscher, Ferdinand; Schwentner, Christian; Radmayr, Christian; Horninger, Wolfgang; Plas, Eugen

doi:10.1111/iju.12542

Cited by 8 publications

(9 citation statements)

References 23 publications

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“…Consistent with these findings, the study by Lunacek et al . has once again corroborated that PNB combined with prior administration of lidocaine suppository compared with PNB alone significantly reduces the PB‐related pain by reducing discomfort related to the TRUS probe insertion and/or manipulations, and PNB punctures …”

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confidence: 68%

Editorial Comment to Combination of lidocaine suppository and periprostatic nerve block during transrectal prostate biopsy: A prospective randomized trial

Salagierski

2014

Int J of Urology

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Editorial Comment Editorial Comment to Combination of lidocaine suppository and periprostatic nerve block during transrectal prostate biopsy: A prospective randomized trialControversy exists over the pain during prostate biopsy (PB).With the current status of knowledge, the discomfort or pain during transrectal biopsy has two origins: (i) one is arising from insertion and movements of the transrectal ultrasound (TRUS) probe into the rectum, and (ii) the second is related to the needle punctures of the prostatic capsule. Over the years, different methods of analgesia have been used to alleviate the discomfort during PB. Although the periprostatic nerve block (PNB), which relies on periprostatic infiltration with lidocaine, is currently considered a gold standard anesthetic technique during TRUS-guided PB, it does not reduce the pain caused by the insertion of the TRUS probe and application of the PNB. Several prospective randomized trials on different populations have shown the benefit of a combined form of analgesia consisting of topically administered substances (i.e. local anesthetic, analgesic or muscle relaxants) and PNB over PNB alone.1-3 Consistent with these findings, the study by Lunacek et al. has once again corroborated that PNB combined with prior administration of lidocaine suppository compared with PNB alone significantly reduces the PB-related pain by reducing discomfort related to the TRUS probe insertion and/or manipulations, and PNB punctures. 4 The results of the present study, although convincing, are not always self-explanatory and leave some unanswered questions: What might have been the mechanism of pain reduction by combined anesthesia during the sampling part of the PB? This synergistic effect has not been reported previously. Was there an age-related difference in the perception of pain? Younger patients generally tend to report increased pain, and for that group the combined local anesthesia might be of greatest benefit. What was the reason for including study patients undergoing subsequent PB (19.5%)? This selection makes the series less homogenous.I do not agree with the authors that "significant proportion of biopsies continue to be carried out without any type of anesthesia". This was probably true a decade ago at the time of the publication of Fink et al., but it does not seem to be the case any more.5 I am also not very convinced, at least based on my own experience, about the reported much increased pain sensation during the PNB. Periprostatic injections are carried out with a very thin 22-G spinal needle, which by itself hardly ever leads to any pain perception. Despite some doubts about the pain sensation during PNB, it is always necessary to reduce the pain, especially when it can be easily achieved. I strongly support the authors' opinion that their study gives further evidence that the "use of low-dose intravenous sedation or general anesthesia is not required during PB".To summarize, the authors are to be commended for the present study. Based on the obtained results, to...

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confidence: 68%

Editorial Comment to Combination of lidocaine suppository and periprostatic nerve block during transrectal prostate biopsy: A prospective randomized trial

Salagierski

2014

Int J of Urology

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“…Periprostatic nerve block has generally become a preferable method of anesthesia due to positive results such as low side effect profile and efficiency in pain control [ 16 – 19 ]. Peripheral nerve block provides temporary anesthesia/analgesia by giving local anesthetic around peripheral nerves around each neurovascular bundle.…”

Section: Discussionmentioning

confidence: 99%

“…Lunacek et al measured VAS as 1 during the TRUS-Bx operation made by applying PNB anesthesia with 60-mg lidocaine suppository+ a total of 10 ml 2% lidocaine (200 mg). They used an 18 G needle during the operation [ 19 ]. It was observed that these results were rather close to our study.…”

Section: Discussionmentioning

confidence: 99%

What should be done to minimize pain without any sexual function deterioration in the transrectal prostate biopsy ?

Sönmez

Kozanhan

Demirelli

et al. 2017

CEJU

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IntroductionThe aim of this study was to find an ideal method for the application of a transrectal ultrasound-guided prostate biopsy (TRUS-Bx) without deteriorating patient comfort.Material and methodsTRUS-Bx was applied in a total of 93 patients. Taking the application method into consideration, these patients were divided into three groups, each consisting of 31 patients. Methods applied for pain control in the different groups were compared (groups 1, 2 and 3). Age, prostate specific antigen (PSA), prostate volume, cancer detection rate, re-biopsy consent ratio, complication rates, visual analog scale (VAS), and International Index of Erectile Function (IIEF-5) scores were compared among the groups.ResultsAge, PSA, prostate volume, cancer detection rate, and fever complication rate were not statistically different between the three groups. However, a statistically significant difference was detected among the groups for the VAS measured during and after TRUS-Bx, re-biopsy consent ratio, and hematuria (p <0.001, p <0.001, p <0.001, and p = 0.027, respectively). There was no detected difference in pre-operation IIEF-5 scores, but the difference in IIEF-5 scores in the first month after the operation was significant (p = 0.116, p = 0.024, respectively).ConclusionsAnal dilatation after the application of intrarectal topical anesthetic to provide anesthesia during TRUS-Bx and giving lidocaine hydrochloride with epinephrine for periprostatic nerve blockage (PNB) is a successful and effective method to maintain patient comfort, especially as it relates to pain control and sexual function. Anal dilatation seems to minimize any pain that may occur due to probe transition, and adding epinephrine as a vasopressor to the anesthetic agent chosen during the operation will be rather helpful for hemostasis control and pain that results from the needle.

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“…Ozden et al [20] reported that 10 cc 1% lidocaine injections provided significantly better pain control than lower doses for PPNB in their placebo controlled, prospective, randomized study. Lunacek et al [21] assessed 123 patients in their prospective, randomized, double-blind clinical trials. They reported that the combination of perianal intrarectal lidocaine gel application and periprostatic 10 mL, 2% lidocaine infiltration is more effective for pain control than either lidocaine gel application or periprostatic lidocaine infiltration alone.…”

Section: Discussionmentioning

confidence: 99%

Comparison of two different doses of lidocaine on the pain sensation during transrectal ultrasound-guided prostate biopsy

Ateş

Dursun²,

Malkoç

et al. 2016

Turkish Journal of Urology

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Objective: To compare two different doses of lidocaine used for periprostatic nerve block on pain perception during transrectal ultrasound (TRUS) guided prostate biopsy. Material and methods:A total of 288 patients with elevated prostate specific antigen (PSA) levels and/or abnormal digital rectal examination who underwent TRUS-guided prostate biopsy were included in the study. The patients were divided into 3 groups: Group 1 (n=103) prostate biopsy were performed after administering perianal intrarectal application of 10 mL 2% lidocaine gel, Group 2 (n=98) 2 mL of 2% lidocaine injection on each side following rectal installation of lidocaine gel and Group 3 (n=87) 4 mL of 2% lidocaine injection on each side after rectal instillation of lidocaine gel. Patients' pain scores during biopsy procedure were reported using visual analogue score (VAS). Independent sample t test, ANOVA test and Tukey test were used for statistical evaluation.

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Combination of lidocaine suppository and periprostatic nerve block during transrectal prostate biopsy: A prospective randomized trial

Cited by 8 publications

References 23 publications

Editorial Comment to Combination of lidocaine suppository and periprostatic nerve block during transrectal prostate biopsy: A prospective randomized trial

Editorial Comment to Combination of lidocaine suppository and periprostatic nerve block during transrectal prostate biopsy: A prospective randomized trial

What should be done to minimize pain without any sexual function deterioration in the transrectal prostate biopsy ?

Comparison of two different doses of lidocaine on the pain sensation during transrectal ultrasound-guided prostate biopsy

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