(Ultrasound Review) According to urologists in Milan, a single injection of local anesthesia into the prostate significantly decreases the pain associated with transrectal prostate biopsy.
They assessed 200 consecutive patients, and the latter half was given local anesthesia preceding biopsy. Following the procedure, patients were asked to complete a questionnaire that assessed the level of pain they had experienced during the examination. The Journal of Urology published this study in the January issue.
Patients were divided into two groups. Group One consisted of 100 patients who had a single bolus injection of 10 ml of lidocaine administered 2-4 minutes prior to biopsy. Group Two underwent the same transrectal biopsy without local anesthesia.
"Antibiotic prophylaxis was achieved by administering a second-generation cephalosporin intravenously 30 minutes before the procedure, followed by ciprofloxacin orally for the next 4 days," the researchers said. Patients with evidence of urinary tract infection were given antibiotics until urine culture was clear. Patients taking anticoagulant therapy were given low molecular weight heparin for one week prior to the biopsy procedure.
Using the left lateral decubitus position with the knees raised towards the chest, a sagittal image of the prostate was obtained using a 7-MHz probe. Under ultrasound guidance, a 22-gauge needle was advanced to the apex in the midline "until its tip was visualized within the plane delimited anterior by the periprostatic fascia and posterior by Denonvilliers’ fascia." This was the needle position used for injection of local anesthesia.
Injection of fluid created a plane between the periprostatic fascia and Denonvilliers’ fascia that reached the seminal vesicles. Although not detailed by the authors, it is assumed that a transrectal needle guide was attached to the ultrasound probe and used for anesthetic injection and biopsies. An average of 12 biopsies were performed per patient.
Ninety-three percent of Group One patients reported only slight discomfort during biopsy and 7% needed to have further local anesthesia (1 cc lidocaine). Fifty-five percent of Group Two patients reported significant but tolerable pain, 35% reported unbearable pain, and 10% required sedation with midazolam. The authors concluded that "a single injection of local anesthesia for prostatic biopsy proved to be efficient, well tolerated by patients, and effective for decreasing the pain associated with the procedure."
"A single injection of lidocaine as local anesthesia for ultrasound-guided needle biopsy of the prostate"
Gianluigi Taverna et al
Dept of Urology, Instituto Clinico Humanitas, Rozzano, Italy
The Journal of Urology 2002 (January); 167:222–223
By Ultrasound Review
February 12, 2002
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