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

Abstract

PurposeProstate biopsy for diagnosing cancer can be painful. The efficacy and safety of combination perianal-intrarectal lidocaine-prilocaine (PILP) cream and periprostatic nerve block were compared with nerve block alone during transrectal ultrasound guided prostate biopsy (TRUS-Bx).Materials and MethodsFrom October 2007 to August 2009, 74 men undergoing a transrectal prostate biopsy were randomized into two groups. In group 1, 36 patients received a combination of PILP cream and a periprostatic nerve block; and in group 2, 38 patients received lubricant jelly and a periprostatic nerve block. Thirty minutes later, the TRUS-Bx was performed. Pain was evaluated by a 10-point visual analogue scale (VAS) after the biopsy.ResultsPatients in group 1 showed a significantly lower VAS score than patients in group 2 (mean score 2.22±0.89 vs. 3.02±1.15, p<0.001). In addition, there was a difference in the number of patients that had a pain score of three or more, 44% in group 1, and 65% in group 2. The overall complication rate was similar in both groups (p=0.45).ConclusionsA combination of PILP cream and periprostatic nerve block reduced pain compared to the periprostatic nerve block alone. This safe, simple technique can be considered prior to TRUS-Bx to reduce patient discomfort.

Efficacy and cost analysis of transrectal ultrasound-guided prostate biopsy under monitored anesthesia

“…Autorino et al 18 reviewed that periprostatic nerve blocks required one or more extra needle punctures and can be associated with a higher incidence of infectious complications. Though Noh et al 4 reported in Korean Journal of Urology that the combination of periprostatic nerve block and lidocaine gel instillation showed an excellent performance, it is presumed that trials like this are in their early stage. As the periprostatic nerve block is not yet tried in our hospital either, we compared MAC group with lidocaine jelly group.…”

“…2,3 Some examples of anesthetics that may be used during TRUS-guided biopsies include intrarectal lidocaine gel, periprostatic nerve blockers, sedation and caudal blockage. [4][5][6] Peters et al 7 reported the first use of propofol during TRUS-guided biopsies, and observed significantly decreased patient discomfort. However, they performed sextant biopsies in different with current extended biopsy methods, and cost was not considered.…”

Addition of intrarectal local analgesia to periprostatic nerve block improves pain control for transrectal ultrasonography‐guided prostate biopsy: A systematic review and meta‐analysis

“…Figure shows the flowchart of the study inclusion process. There were 18 studies involving 2076 patients finally eligible for the quantitative analysis, including 16 RCTs and two retrospective studies . The risk of bias was presented with a risk of bias graph (Fig.…”

“…Six studies used lidocaine gel 4,10-14 for IRLA, six used lidocaine-prilocaine cream, [15][16][17][18][19][20] three used GTN ointment [21][22][23] and three used a diclofenac suppository. 6,24,25 PPNB was accomplished by a 22-G needle under ultrasound guidance into the neurovascular bundle at the base of the prostate, just lateral to the junction between the prostate and seminal vesicle bilaterally in all, but not specified in three studies.…”

Evaluation of the efficacy of a combination of diltiazem and periprostatic nerve block in pain control during transrectal ultrasonography-guided biopsy of the prostate

“…9,10 PPNB effectively reduces the pain due to the insertion of the needle in the prostate but it is ineffective in decreasing the pain of the insertion of the probe into the rectum. 2,8,11 In order to reduce the pain of the probe insertion, drugs should be added that have an effect on the anal sphincter. Diltiazem is a drug that has been used in the treatment of anal fissures.…”