Anorectal Application of 5% Lidocaine Cream Reduces Pain Prior to Periprostatic Nerve Block during Transrectal Ultrasound Guided Prostate Biopsy: Randomized, Prospective Controlled Study

Rappaport YH1*, Kravchick S2*, Neheman A1 , Beberashvili I2 , Stav K1 , Roizman S1 and Zisman A1

1 Department of Urology, Shamir Medical Center, Israel 2 Department of Nephrology, Tel-Aviv University, Israel

^*Correspondance to: Yishai H Rappaport 

 PDF  Full Text DOI: 10.25107/2474-1647.2946

Abstract

Objectives: Fusion prostate biopsy using the trans-rectal approach (TRUSgBx) are performed with Periprostatic Nerve Block (PPNB) done following probe insertion and manipulation leaving these initial maneuvers uncovered in terms of pain control. We evaluated whether topical analgesia reduces pain during early stages of TRUSgBx. Patients and Methods: Seven group prospective, randomized controlled study: Groups 1-3: Nerve block with 5 ml 1% lidocaine bilaterally plus perianal topical application of 10 ml 5% lidocaine cream. Groups 4-6 as in 1-3 plus digital application of 10 ml 5% lidocaine cream internally on rectal walls. For each approach exposure times were 5 (group 1,4), 10 (2,5) and 20 (3,6) minutes. The control group (7) received PPNB only. Patients filled a 0-10 VAS at 5 points: After probe insertion, during probe manipulation, following PPNB, after prostate biopsies and global pain estimation. Results: 252 patients were enrolled. Significant differences in VAS between all study groups and controls were observed at the pre-biopsy stages of the procedure. In multivariate analysis adjusted for PSA, DM status, spinal disease, abnormal DRE and non-BPH histology, significance remained for probe insertion and intra-rectal manipulation. For each exposure time no significant differences were observed between topical application and topical + intra-rectal application. After PPNB, differences between study and control groups disappeared. Conclusion: Topical anesthesia significantly reduces pain during early stages of prostate biopsy. Perianal application suffices whereas intra-rectal application of local anesthetics does not add to pain control. Perianal application for 10 min seems to be optimal.

Keywords

Anal canal; Biopsy; Lidocaine; Pain; Prostate

Cite the article

Rappaport YH, Kravchick S, Neheman A, Beberashvili I, Stav K, Roizman S, et al. Anorectal Application of 5% Lidocaine Cream Reduces Pain Prior to Periprostatic Nerve Block during Transrectal Ultrasound Guided Prostate Biopsy: Randomized, Prospective Controlled Study. Clin Surg. 2020; 5: 2946..