The Optimum Doses of and Injection Locations for Periprostatic Nerve Blockade for Transrectal Ultrasound Guided Biopsy of the Prostate: A Prospective, Randomized, Placebo Controlled Study

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Abstract
We evaluated the efficiency of various amounts of local anesthesia and various numbers of injection sites to determine the most effective pain control with the least number of injections and the amount of injected medium in patients who underwent transrectal ultrasound guided prostate biopsy.Transrectal ultrasound guided 8 core biopsy of the prostate was performed in 175 consecutive men. Patients were randomized into 7 groups with 25 per group. Group 1 received 5 cc saline and groups 2 to 7 received 2.5, 5 or 10 cc 1% lidocaine injected as local anesthesia at basal or basal plus apical locations. The patients were then evaluated for pain and other complications to determine whether there was a difference regarding groups.Mean pain scores were significantly lower than in saline group for all anesthesia injected groups except group 2 with a 2.5 cc bilateral basal injection. The most effective pain control was achieved by 10 cc anesthetic injections. Basal plus apical injections were not superior than only basal injections for pain control. There was no significant difference in the hematuria, hematospermia, rectal bleeding or infection rate among the groups. Increasing the number of injections and amount of lidocaine had no effect on complication rates.Our placebo controlled, prospective, randomized study indicated that 10 cc local anesthetic injections supply significantly better pain control than lower doses for periprostatic nerve blockade during prostate biopsy. Although bilateral basal plus apical 10 cc lidocaine injections resulted in the lowest mean pain score, there was no statistically significant difference from 10 cc bilateral basal injections.