Combination of Perianal-Intrarectal Lidocaine-Prilocaine Cream and Periprostatic Nerve Block for Pain Control During Transrectal Ultrasound Guided Prostate Biopsy: A Randomized, Controlled Trial

Giannarini, Gianluca; Autorino, Riccardo; Valent, Francesca; Mogorovich, Andrea; Manassero, Francesca; Maria, Maurizio De; Morelli, Girolamo; Barbone, Fabio; Lorenzo, Giuseppe Di; Selli, Cesare

doi:10.1016/j.juro.2008.10.002

Cited by 70 publications

(98 citation statements)

References 22 publications

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“…VAS pain scores were higher in patients with a small prostate and the difference was statistically significant in our study on the contrary to result of Giannarini et al and Yun et al 16,23 There may be more pressure to neurovascular bundle due to large size of prostate then some decrease may occure in transmission of pain percaption in those patient with large prostate. According to recent reports, higher prostate volumes do not necessarily increase the pain associated with the procedure.…”

Section: Discussioncontrasting

confidence: 98%

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Evaluating the Factors Associated with Pain Perception During Transrectal Ultrasound Guided Prostate Biopsy: Is Music One of Them?

Yılmaz¹,

Okçelik²,

Ateş³

et al. 2015

Turkiye Klinikleri J Urology

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A AB BS S TTR RA AC CT T O Ob bj je ec ct ti iv ve e: : Transrectal ultrasound guided prostate biopsy (TRUS-Bx) is essential in diagnostic investigation of patients with clinical suspicion of prostatic neoplasia. Despite the effective local anaesthesia some patients can not tolerate the procedure easily due to pain. The aim of our study was evaluating the factors that effect pain perception during TRUS-Bx and also evaluating the effect of listening to music on pain perception during the procedure. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : This prospective study was performed in our department between May and November 2014. The patients were divided in two groups. Group 1: Patients listened to music, Group 2: Patients who did not listen to music. 5% lidocain cream and periprostatic enjection with 4 cc lidocain each side of prostate were applied for local anaesthesia to all patients. Twelve or more cores or biopsy samples were taken. Age, count of biopsy, prostate volume, pain scores during rectal probe insertion, periprostatic enjection and needle insertion by using visual analog scale (VAS) from 0 to 10 were recorded. R Re es su ul lt ts s: : Fifty-one patients were enrolled (26 listened to music, 25 no listened). Mean age, PSA level, prostate volume, biopsy core count, length of biopsy time were 63.5 years, 12.9 ng/dl, 56.4 cc.,13.1 cores, 8.1 minutes respectively. Mean pain score during probe insertion, periprostatik enjection and needle insertion were 0.88, 0.84 and 0,92 respectively. Music, age and PSA level did not effect the pain scores. The only variable that effected the pain scores was prostatic volume. Patients with small prostate (<50 cc) felt more pain (p=0,007). C Co on nc cl lu us si io on n: : We demonstrated that prostatic volume is the only effective variable in pain perception during TRUS biopsy and listening to music could not be benefical for pain in prostate biopsy. K Ke ey y W Wo or rd ds s: : Pain perception; biopsy; music; prostatic neoplasms; anesthesia, local Ö ÖZ ZE ET T A Am ma aç ç: : Prostat kanseri şüphesi olan hastalarda transrektal ultrason yardımlı prostat biyopsisi tanı için gereklidir. Her ne kadar lokal anestezi etkili olsa da bazı hastalar ağrı nedeni ile işlemi kolay tolere edemez. Bu çalışmanın amacı prostat biyopsisi esnasında oluşan ağrı üzerine etkili parametreleri tespit etmek ve işlem esnasında müzik dinlemenin ağrı hissine etkisini araştırmaktır. G Ge er re eç ç v ve e Y Yö ön n--t te em ml le er r: : Bu çalışma kliniğimizde Mayıs-Aralık 2014 tarihleri arasında prostat biyopsisi yapılan hastalar üzerinde prospektif, randomize olmayan şekilde yapılmıştır. Biyopsi yapılacak hastalar işlem esnasında klasik müzik dinleyen ve dinlemeyen olarak iki gruba ayrıldı. Tüm hastalara %5 lidokain içeren krem ile anal kanala, prostatın herbir tarafına 4 cc lidokain enjeksiyonu ile periprostatik alana lokal anestezi uygulandı.Tüm hastalardan standart 12 kor veya daha fazla biyopsi örneği alındı. Yaş, biyopsi sayısı, prostat hacmi, rektal probun uygulanması esnasınd...

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Section: Discussioncontrasting

confidence: 98%

“…15 We also use combined anaesthesia which is suggested by Giannarini in our routine prostate biopsy procedures. 16 We believe in that administering perianal-intrarectal lidocaine cream before probe insertion decreases pain perception related to probe.…”

Section: Discussionmentioning

confidence: 98%

Evaluating the Factors Associated with Pain Perception During Transrectal Ultrasound Guided Prostate Biopsy: Is Music One of Them?

Yılmaz¹,

Okçelik²,

Ateş³

et al. 2015

Turkiye Klinikleri J Urology

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“…Similarly, Giannarini et al found that the combination of perianal-intrarectal lidocaine-prilocaine cream and PPNB was able to provide better pain control than the two modalities alone, with no increase in the complication rate. The magnitude of this effect was higher in younger men, especially if with an enlarged prostate and lower anorectal compliance 44 .A recent meta-analysis confirmed that the combination of local analgesia and PPNB significantly reduced pain associated with probe manipulation, anesthesia, infiltration and needle biopsy. Subgroup analyses suggest that lidocaine-prilocaine cream proved the most effective pain control regardless of the origin of pain 38 .…”

Section: Painmentioning

confidence: 93%

Complications After Systematic, Random, and Image-guided Prostate Biopsy

et al. 2017

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Evidence Synthesis: The most frequent complication after PB is minor and self-limiting bleeding (hematuria and hematospermia), irrespective of the biopsy approach. Occurrence of rectal bleeding was comparable among traditional TRUS-guided and image-guided PB. Almost 25% of patients experience lower urinary tract symptoms, but only a few have urinary retention, with higher rates after transperineal approach. Temporary erectile dysfunction is not negligible, with a return to baseline after 1-6 months. The incidence of infective complications is being increasing, with higher rates among men with medical comorbidities and older age. Transperineal and in-bore MRI targeted biopsy may reduce the risk of severe infectious complications. Mortality after PB is uncommon, irrespective of biopsy technique. Conclusions:Complications after PB are frequent but often self-limiting. The incidence of hospitalization due to severe infections is continuously increasing. Still, a careful appraisal of 3 patient's general health status, risk factors and likelihood of antimicrobial resistance should be done before scheduling a PB. Patient Summary:In this paper we reviewed the variety and incidence of complications after prostate biopsy. Even if frequent, seldom represent a problem for the patient. The most troublesome complications are infections. In order to minimize this risk, a careful evaluation of patient's medical condition must be done before biopsy.4

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“…These results suggest that a large dose of lidocaine-prilocaine (5g) intrarectal application 30 minutes prior to the procedure itself can achieve certain anesthetic effect on not only the procto canal but also the prostate gland. 63 …”

Section: Combination Peri-prostatic Block and Intra-rectal Local Anesmentioning

confidence: 99%

“…17,20,69,70 No significant complication differences were found with intraprostatic analgesia injection 64,67,68 or topical agents. 22,63,71 Of note, reported morbidity is confounded by the fact that many of the complications (i.e. bleeding, infection) can result from the prostatic biopsy itself (i.e.…”

Section: Complicationsmentioning

confidence: 99%