Combination of Oral Tramadol, Acetaminophen and 1% Lidocaine Induced Periprostatic Nerve Block for Pain Control During Transrectal Ultrasound Guided Biopsy of the Prostate: A Prospective, Randomized, Controlled Trial

Abstract

Prostate biopsy for diagnosing cancer can be painful. Tramadol is a centrally acting analgesic used to treat many pain disorders. We determined whether administering oral tramadol and acetaminophen combined with 1% lidocaine induced periprostatic nerve block would significantly decrease the pain experienced by patients during standard 10-core transrectal ultrasound guided needle biopsy of the prostate. A total of 60 men who presented for diagnostic prostate biopsy were randomized to receive placebo plus periprostatic 1% lidocaine as the control group of 30 or 75 mg tramadol/650 mg acetaminophen orally plus periprostatic 1% lidocaine as the experimental group of 30 before undergoing biopsy. Immediately after biopsy each patient was asked to rate the pain on a linear 10-point scale and a standard 6-point faces pain scale. Complications of pain medication administration in each group were noted and compared. Pain medication administration was well tolerated by each study group except for lightheadedness/dizziness and itching in 1 patient each in the experimental group, and lightheadedness/dizziness in 1 patient in the control group. Overall patients in the experimental group reported a mean decrease +/- SD in the pain score of 2.3 +/- 2.4 on the scale of 1 to 10 (p = 0.0008) and 1.11 +/- 1.25 on the scale of 0 to 5 compared with scores in controls (p = 0.0009). Administering 75 mg tramadol/650 mg acetaminophen orally with periprostatic 1% lidocaine before transrectal ultrasound guided prostate biopsy is a safe, easy and effective method of controlling pain during the biopsy procedure.