Transrectal Ultrasound Guided Prostatic Nerve Blockade Eases Systematic Needle Biopsy of the Prostate

Abstract

Purpose We assessed the effect of transrectal ultrasound guided prostatic nerve blockade on the discomfort associated with systematic needle biopsy of the prostate. Materials and Methods A prospective randomized double-blind study was performed of 64 patients requiring systematic biopsy of the prostate. Patients were randomly assigned to receive an injection of 5 ml. 1 percent lidocaine or 5 ml. saline (0.9 percent sodium chloride) at the vascular pedicle on 1 side of the prostate only. They were then asked to score the severity of discomfort of the injection and subsequent biopsies on each side. Results Mean pain scores were significantly lower on the side with than the side without lidocaine injection (1.6 plus/minus 0.9 versus 2.4 plus/minus 1.2, p less than 0.0001) and not significantly different when saline was injected (2.9 plus/minus 1.2 versus 3.0 plus/minus 1.1, p = 0.52). Pain scores were significantly different when the lidocaine injected side was compared to the saline solution injected side (p less than 0.0001) but the difference was not significant between the noninjected sides of the 2 groups (p = 0.076). Of the patients in the lidocaine group 68 percent reported that they would prefer to undergo biopsy with the injection compared to only 41 percent in the placebo group (p = 0.037). During the study no patient in either group had any adverse effect from the injection. Conclusions Transrectal ultrasound guided nerve blockade before prostatic biopsy results in a more comfortable procedure for the patient.