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Combination of Perianal-Intrarectal Lidocaine-Prilocaine Cream and Periprostatic Nerve Block for Pain Control During Transrectal Ultrasound Guided Prostate Biopsy: A Randomized, Controlled Trial
- Source :
- Journal of Urology. 181:585-593
- Publication Year :
- 2009
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2009.
-
Abstract
- To our knowledge the optimal analgesia during prostate biopsy remains undetermined. We tested the efficacy and safety of combined perianal-intrarectal lidocaine-prilocaine cream and periprostatic nerve block during transrectal ultrasound guided prostate biopsy.A total of 280 patients were randomized to receive combined perianal-intrarectal lidocaine-prilocaine cream and periprostatic nerve block (group 1), perianal-intrarectal lidocaine-prilocaine cream alone (group 2), periprostatic nerve block alone (group 3) or no anesthesia (group 4) before transrectal ultrasound guided prostate biopsy. Pain was evaluated with a 10-point visual analog scale at subsequent procedural steps, including perianal-intrarectal substance administration, prostate transrectal ultrasound, periprostatic nerve block and sampling. Complications were assessed by self-administered questionnaire and telephone interview.The groups were comparable in patient age, prostate volume, pathology results and visual analog scale perianal-intrarectal substance administration. Visual analog scale results for transrectal ultrasound were lower in groups 1 and 2 vs 3 and 4 (mean 1.5 and 1.41 vs 5.37 and 5.31, p0.001) and results for periprostatic nerve block were lower in group 1 vs 3 (mean 1.03 vs 3.74, p0.001). Results for sampling were lower in groups 1 to 3 vs 4 (mean 0.77, 1.27 and 1.27 vs 4.33, p0.001) and in group 1 vs 2 and 3 (p0.001). Stratified analysis showed that visual analog scale sampling was lower in group 1 vs 2 and 3 in patients 65 years old or younger, those with a prostate greater than 49 cc and those with lower anorectal compliance (visual analog scale results for perianal-intrarectal substance administration greater than 2) (p = 0.006,0.001 and 0.003, respectively). The overall complication rate was similar in all 4 groups (p = 0.87).Our findings suggest that the combination of perianal-intrarectal lidocaine-prilocaine cream and periprostatic nerve block provides better pain control than the 2 modalities alone during the sampling part of transrectal ultrasound guided prostate biopsy with no increase in the complication rate. The magnitude of this effect is higher in younger men, men with a larger prostate and men with lower anorectal compliance.
- Subjects :
- Male
medicine.medical_specialty
Prostate biopsy
Lidocaine/prilocaine
Visual analogue scale
Administration, Topical
Urology
medicine.medical_treatment
Pain
Perineum
Risk Assessment
Ointments
Periprostatic
Reference Values
Prostate
Humans
Medicine
Lidocaine, Prilocaine Drug Combination
Ultrasound, High-Intensity Focused, Transrectal
Aged
Pain Measurement
Probability
Analysis of Variance
Chi-Square Distribution
medicine.diagnostic_test
business.industry
Biopsy, Needle
Rectum
Lidocaine
Prostatic Neoplasms
Nerve Block
Middle Aged
Combined Modality Therapy
Prilocaine
Ultrasound-Guided Prostate Biopsy
Surgery
Prostate-specific antigen
medicine.anatomical_structure
Patient Satisfaction
Multivariate Analysis
Linear Models
Nerve block
Analgesia
business
Follow-Up Studies
medicine.drug
Subjects
Details
- ISSN :
- 15273792 and 00225347
- Volume :
- 181
- Database :
- OpenAIRE
- Journal :
- Journal of Urology
- Accession number :
- edsair.doi.dedup.....ad07391a77952558ce8e29d143e648b3