49523
document
Noninfiltrative anesthesia for transrectal prostate biopsy : a randomized prospective study comparing lidocaine-prilocaine cream and lidocaine-ketorolac gel . OBJECTIVES Periprostatic nerve block ( PPNB ) is the standard anesthesia for ultrasound ( US ) guided transrectal prostate biopsy ( TPB ) , but periprostatic infiltration itself constitutes a major , though often neglected , source of discomfort even in patients receiving perianal-intrarectal lidocaine-prilocaine ( PILP ) cream before PPNB . Noninfiltrative anesthesia therefore represents an attractive alternative to periprostatic infiltration . With this in mind , we aimed to determine the efficacy and safety of perianal-intrarectal ( PI ) lidocaine gel , lidocaine-ketorolac gel , and lidocaine-prilocaine cream in relieving pain during TPB . MATERIALS AND METHODS Three hundred consecutive patients scheduled for US-guided TPB were randomized 1:1:1 to receive PI administration of 5 g 2.5 % lidocaine gel 10 minutes before TPB ( Group 1 ) , or a mixture of 5 g 2.5 % lidocaine gel and 0.3 % ketorolac tromethamine solution 1 hour before TPB ( Group 2 ) , or 5 g 2.5 % lidocaine and 2.5 % prilocaine cream 20 minutes before TPB ( Group 3 ) . The 0-to-10 points visual analogue scale ( VAS ) was used for assessing pain at probe insertion and movements ( VAS-1 ) , at prostate sampling ( VAS-2 ) , and maximal procedural pain ( MPP ) . Complications occurring up to 20 days after the procedure were also recorded . RESULTS Four ( 1.3 % ) patients were excluded because of unbearable pain during the procedure , leaving Group 1 with 98 patients , Group 2 with 99 , and Group 3 with 99 ; the 3 groups were comparable for patients ' age , serum PSA , prostate volume , and cancer detection rate . The addition of either ketorolac or prilocaine to lidocaine significantly ( P < 0.0001 ) reduced probe-related , sampling-related , and maximal procedural pain . Compared with lidocaine-prilocaine , lidocaine-ketorolac was less effective in relieving probe-related pain ( mean VAS-1 : 1.47 ± 1.30 vs. 0.39 ± 0.65 ; P < 0.0001 ) but more effective in relieving sampling-related pain ( mean VAS-2 : 0.76 ± 0.94 vs. 1.54 ± 1.02 ; P < 0.0001 ) ; there was no difference in MPP ( mean 1.82 ± 1.21 vs. 1.67 ± 0.95 ) , probably due to such different efficacy on the two pain sources . Complications were similar in the 3 groups . CONCLUSIONS Lidocaine-prilocaine cream was most effective on probe-related pain , whereas lidocaine-ketorolac gel was most effective on sampling-related pain . These noninfiltrative anesthetics were safe , easy to administer , and well accepted by patients ; the possibility to combine them to further improve pain control during TPB deserves further well-designed studies .
49524
Intervention_Pharmacological
Noninfiltrative anesthesia
49525
Intervention_Surgical
transrectal prostate biopsy
49526
Intervention_Pharmacological
lidocaine-prilocaine cream
49527
Intervention_Pharmacological
lidocaine-ketorolac gel
49528
Intervention_Pharmacological
anesthesia
49529
Intervention_Pharmacological
perianal-intrarectal lidocaine-prilocaine ( PILP ) cream
49530
Intervention_Pharmacological
Noninfiltrative anesthesia
49531
Intervention_Pharmacological
perianal-intrarectal ( PI ) lidocaine gel
49532
Intervention_Pharmacological
lidocaine-ketorolac gel
49533
Intervention_Pharmacological
lidocaine-prilocaine cream
49534
Intervention_Pharmacological
lidocaine gel
49535
Intervention_Pharmacological
5 g 2.5 % lidocaine gel and 0.3 % ketorolac tromethamine solution
49536
Intervention_Pharmacological
5 g 2.5 % lidocaine and 2.5 % prilocaine cream
49537
Intervention_Pharmacological
ketorolac
49538
Intervention_Pharmacological
prilocaine
49539
Intervention_Pharmacological
lidocaine
49540
Intervention_Pharmacological
lidocaine-prilocaine
49541
Intervention_Pharmacological
lidocaine-ketorolac
49542
Outcome_Other
efficacy and safety
49543
Outcome_Pain
relieving pain
49544
Outcome_Pain
0-to-10 points visual analogue scale ( VAS )
49545
Outcome_Pain
unbearable pain
49546
Outcome_Physical
serum PSA , prostate volume , and cancer detection rate
49547
Outcome_Pain
procedural pain
49548
Outcome_Pain
probe-related pain
49549
Participant_Condition
transrectal prostate biopsy
49550
Participant_Condition
transrectal prostate biopsy
49551
Participant_Condition
TPB
49552
Participant_Sample-size
Three hundred
49553
Participant_Condition
TPB