Pain after transrectal ultrasonography‐guided prostate biopsy: the advantages of periprostatic local anaesthesia

Abstract

Objective To prospectively evaluate the ef®cacy and safety of periprostatic local anaesthesia (LA) during prostatic biopsy guided by transrectal ultrasonography (TRUS), as 20±65% of men report moderate to severe pain, and there is anecdotal and published evidence that periprostatic anaesthesia improves patients' tolerance. Patients and methods In all, 157 patients were prospectively recruited and sequentially randomized to receive either LA or no anaesthesia. Sextant biopsies were taken in all men but some had more than six biopsies. All were asked to complete questionnaires immediately after TRUS-guided biopsy and for the subsequent week, giving pain scores and recording any morbidity, including symptoms of infection; analgesic use was also surveyed. Results Patients given LA had signi®cantly lower pain scores at the time of biopsy than those given no anaesthesia, with median (SD) pain scores of 1.53 (0.7) and 1.95 (0.65) (P<0.001), respectively. In addition, there was a trend towards less analgesic use by those given LA, although this was not statistically signi®cant. There was no difference in the amount of haematuria, haematochezia or haematospermia, or infection rate, between the groups. The additional cost and time of the procedure was minimal (£3.00 and 3 min/per patient, respectively). Conclusion Periprostatic LA in®ltration is a quick and simple procedure which signi®cantly improves immediate pain with no added morbidity; we strongly advocate its use to improve patient tolerance of TRUS-guided prostate biopsy.

A meta-analysis of local anesthesia for transrectal ultrasound-guided biopsy of the prostate

“…In terms of safety, there were no increased complications from biopsy or adverse events from local anesthetic administration reported in all the studies included in the meta-analysis. In addition, Soloway and Obek 12 and others 22,36,40,52 reported no difference in intraoperative findings such as fibrosis or loss of planes between rectum and prostate in patients who underwent prostate biopsies with and without local anesthetic.…”

“…Seymour [52] No adverse events from LA injection. No difference in median number of days (LA vs. CT) of hematuria (2.6 vs 2.3), hematochezia (0.55 vs. 0.36), and hematospermia (0.65 vs. 0.69).…”

“…Randomization methods were judged to be adequate in 10 studies. [34][35][36]42,44,[51][52][53]19,56 They were not specified in the remaining 15 trials. 14,[37][38][39][40][41]43,[45][46][47][48][49][50]54,55 For the trials assessing the efficacy of PPNBs, two types of controls were used.…”

“…20,26,49 Soloway and Obek 12 later modified the technique by placing two further depot injections on each side of the prostate on the lateral aspect. 22 On the other hand, Seymour et al 52 and later Rogriguez et al 50 performed periprostatic infiltration only at the apex at the 4 and 8 O' clock positions. From the apex, local anesthesia spreads along the posterior aspect of the prostate and seminal vesicles under the Denovillier's fasica, achieving sufficient pain control.…”

Associated Clinical Parameters of Pain in Patients Undergoing Trans Rectal Ultrasonography of the Prostate

“…Nevertheless, TRU of the prostate is painful (4), and there were claims from a few patients at our setting that they encountered extreme pain while getting this intrusive technique. Despite the fact that the level of and variables affecting pain amid TRU-guided biopsy were explored in the literature (5)(6)(7), in view of our investigation, there is a dearth of studies that concentrated on pain encountered by the patients undergoing TRU of the prostate.…”