The effect of heated lidocaine gel on pain reduction during transrectal ultrasound-guided prostate biopsy: a randomized-controlled study

Abstract

To determine whether intrarectal local anesthesia (IRLA) with heated lidocaine gel provides pain reduction during transrectal ultrasound (TRUS)-guided prostate biopsy. We conducted a randomized-controlled study with 153 participants who underwent TRUS-guided, systematic 12-core prostate biopsy from May 2018 to June 2019. These participants were divided into three test groups. Before prostate biopsy, group A (51 patients) received no local anesthesia, group B (51 patients) received IRLA with 20mL 2% lidocaine gel stored at room temperature, and group C (51 patients) received IRLA with heated (40 ℃) 20mL 2% lidocaine gel. Pain was assessed using the 0-10 visual analogue scale (VAS) at three time points: VAS-1: during probe insertion, VAS-2: during biopsy, VAS-3: 30min after the procedure. Complications during and after the procedure were evaluated. The mean VAS-2 score was significantly lower in group C compared to groups A and B (A, 4.6; B, 4.2; and C, 3.2; p < 0.05). There was no significant difference among the three groups in mean VAS-1 and VAS-3 scores. No significant difference was detected in incidence of complications between the three groups. No allergic reactions to lidocaine gel were observed. IRLA with heated lidocaine gel provides more effective pain control during TRUS-guided prostate biopsy than does conventional IRLA and no local anesthesia, without an increase of complications.