Lidocaine spray administration during transrectal ultrasound guided prostate biopsy modified the discomfort and pain of the procedure: results of a randomized clinical trial.

Author(s): Dell'Atti L, Daniele C

Affiliation(s): Urology Unit, Arcispedale "S. Anna", Ferrara, Italy. dellatti@hotmail.com

Publication date & source: 2010-06, Arch Ital Urol Androl., 82(2):125-7.

Publication type: Randomized Controlled Trial

OBJECTIVES: We report the results of a study about the possible benefit of lidocaine spray perineal administration before transrectal ultrasound guided biopsy of the prostate. Many patients frequently report some kind of discomfort and (or) pain during this procedure, that when pain is severe, may be necessary to interrupt. MATERIALS AND METHODS: Between September 2007 and October 2009 372 consecutive male patients with elevate PSA and (or) abnormal digital rectal and (or) suspect TRUS were scheduled for prostate biopsy and divided in 3 groups. Group 1 (n = 98) underwent intrarectal instillation of a lidocaine/prilocaine cream (EMLA R), Group 2 (n = 126) of a 2.5% lidocaine gel, and Group 3 (n = 148) administration of a lidocaine spray (10 gr/100 ml) before the procedure. A verbal numerical pain score (VNS) from = 0 no discomfort to 10 = severe pain was admnistrated to the biopsied patients who were asked to evaluate separately the degree of pain associated with the insertion of the probe and the manoeuvres associated with it and the degree of pain associated with the biopsy. RESULTS: The mean value of pain VNS in patients of the first group was respectively 5.3 (2-8) for the insertion of the probe (first question) and 3.2 (2-7) for the biopsy by itself (second question), whereas in the second group it was 6.2 (4-9) and 3.8 (3-8), and in the third group 3.1 (1-6) and 2.8 (0-6). CONCLUSIONS: Pain score results showed that the use of intrarectal lidocaine spray provided significantly better pain control than cream and anaesthetic gel. Our pain score data suggests that lidocaine spray provides efficient patient comfort during prostate biopsy by reducing pain both during probe insertion and insertion of the needle through the prostate gland. The use of lidocaine spray makes an excellent alternative, causing a reduction of anal sphincter tone with better patient compliance and tolerability to the ultrasound probe during biopsies with an optimization in terms of cost-effectiveness of the procedure.