psd-502 and Prostatic-Neoplasms

To our knowledge the optimal analgesia during prostate biopsy remains undetermined. We tested the efficacy and safety of combined perianal-intrarectal lidocaine-prilocaine cream and periprostatic nerve block during transrectal ultrasound guided prostate biopsy.. A total of 280 patients were randomized to receive combined perianal-intrarectal lidocaine-prilocaine cream and periprostatic nerve block (group 1), perianal-intrarectal lidocaine-prilocaine cream alone (group 2), periprostatic nerve block alone (group 3) or no anesthesia (group 4) before transrectal ultrasound guided prostate biopsy. Pain was evaluated with a 10-point visual analog scale at subsequent procedural steps, including perianal-intrarectal substance administration, prostate transrectal ultrasound, periprostatic nerve block and sampling. Complications were assessed by self-administered questionnaire and telephone interview.. The groups were comparable in patient age, prostate volume, pathology results and visual analog scale perianal-intrarectal substance administration. Visual analog scale results for transrectal ultrasound were lower in groups 1 and 2 vs 3 and 4 (mean 1.5 and 1.41 vs 5.37 and 5.31, p <0.001) and results for periprostatic nerve block were lower in group 1 vs 3 (mean 1.03 vs 3.74, p <0.001). Results for sampling were lower in groups 1 to 3 vs 4 (mean 0.77, 1.27 and 1.27 vs 4.33, p <0.001) and in group 1 vs 2 and 3 (p <0.001). Stratified analysis showed that visual analog scale sampling was lower in group 1 vs 2 and 3 in patients 65 years old or younger, those with a prostate greater than 49 cc and those with lower anorectal compliance (visual analog scale results for perianal-intrarectal substance administration greater than 2) (p = 0.006, <0.001 and 0.003, respectively). The overall complication rate was similar in all 4 groups (p = 0.87).. Our findings suggest that the combination of perianal-intrarectal lidocaine-prilocaine cream and periprostatic nerve block provides better pain control than the 2 modalities alone during the sampling part of transrectal ultrasound guided prostate biopsy with no increase in the complication rate. The magnitude of this effect is higher in younger men, men with a larger prostate and men with lower anorectal compliance.

Topics: Administration, Topical; Aged; Analgesia; Analysis of Variance; Biopsy, Needle; Chi-Square Distribution; Combined Modality Therapy; Follow-Up Studies; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Linear Models; Male; Middle Aged; Multivariate Analysis; Nerve Block; Ointments; Pain; Pain Measurement; Patient Satisfaction; Perineum; Prilocaine; Probability; Prostatic Neoplasms; Rectum; Reference Values; Risk Assessment; Ultrasound, High-Intensity Focused, Transrectal

To determine the optimal place to apply the local anesthetic agent and to investigate the efficacy of lidocaine-prilocaine cream on the perianal and intrarectal region during prostate biopsy.. The study included 80 patients. Patients were randomized into four groups: group 1 served as the control group and was administered no anesthesia; group 2 received 5 ml lidocaine-prilocaine cream perianally; group 3 received 5 ml lidocaine-prilocaine cream intrarectally, and group 4 received lidocaine-prilocaine cream perianally and intrarectally. Pain scores during probe insertion, biopsy procedure, and the overall pain score were assessed. Mean pain scores in each group were compared statistically.. In group 1, the mean pain score was significantly higher during probe insertion than that during biopsy (p < 0.001). For the mean overall pain scores, there was no significant difference between groups 1 and 3 (p = 0.942), but the results of group 1 were statistically different from groups 2 (p = 0.001) and 4 (p < 0.001). When we compared the biopsy pain scores, there was no significant difference among the groups (p > 0.05). During probe insertion, subjects in groups 2 and 4 reported significantly lower pain scores than the control group (p = 0.002, p = 0.001, respectively).. Perianal anesthesia with lidocaine-prilocaine cream may solely be sufficient to decrease the pain during prostate biopsy.

Topics: Administration, Rectal; Aged; Anesthetics, Combined; Anesthetics, Local; Biopsy; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Ointments; Pain; Pain Measurement; Prilocaine; Prospective Studies; Prostate; Prostate-Specific Antigen; Prostatic Neoplasms; Treatment Outcome; Ultrasonography, Interventional

The aims of the present study were to evaluate the efficacy of eutectic mixture of local anesthetics (EMLA) cream in transrectal-guided prostate biopsy and to compare its effect with that of other injectable anesthetic procedures.. Eighty male patients with prostate-specific antigen (PSA) levels > 4 ng/ml or who had prostate nodules on digital rectal examination were randomly divided into four groups. In Group 1 (controls), prostate biopsy was performed after application of a placebo cream. In Group 2, local surface anesthesia with EMLA cream was performed 15 min before biopsy. Periprosthetic nerve blockade was performed with 1% prilocaine and 1% lidocaine in Groups 3 and 4, respectively. Pain was evaluated using a visual analog scale (VAS) after each core biopsy. In addition, blood pressure, heart rate and oxygen saturations were recorded after each biopsy and then at 5-min intervals for 15 min.. Average VAS scores in Groups 1-4 were 5.5, 2.9, 2.4 and 2.2, respectively. There was a statistically significant difference in VAS scores between the treatment groups and the placebo group (p = 0.000). There were no statistically significant differences in VAS scores between the three treatment groups (p2-3 = 0.126, p2-4 = 0.303, p3-4 = 0.537). We detected no statistically significant differences between the groups based on the hemodynamic data (pMAP = 0.899). Moreover, these measurements did not show statistically significant changes with time in any of the groups (p > 0. 05).. Intrarectal application of EMLA cream provides equal anesthesia to periprostatic nerve blockade with prilocaine and lidocaine.

Topics: Administration, Rectal; Aged; Anesthesia, Local; Anesthetics, Local; Biopsy; Endosonography; Humans; Injections; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Ointments; Pain; Pain Measurement; Prilocaine; Prostate; Prostate-Specific Antigen; Prostatic Neoplasms; Rectum

To assess the effectiveness of perianal and intrarectal lidocaine-prilocaine cream for prostate biopsy.. In a prospective, randomized, double-blind, placebo-controlled study, 200 consecutive patients were randomized to receive 5 mL lidocaine-prilocaine cream or 5 mL placebo peri-anally and transrectally before transrectal ultrasonography (TRUS)-guided prostate needle biopsy (mean number of cores, 12). The men were asked to grade the pain when the TRUS probe was inserted and during the biopsy procedure using a 10-point linear visual analogue pain scale.. At probe insertion, men in the anaesthetic group reported a significantly lower mean pain level than men in the placebo group (0.3 vs 1.6, P < 0.001). Men who had anaesthetic also reported less pain during biopsy punctures (1.8 vs 3.2, P < 0.001). Stratifying results by age, younger men (< 67 years) benefited more from anaesthesia during probe insertion (0.9 vs 1.7; P = 0.04) and biopsy (1.8 vs 4.0, P < 0.001) than older men (1.0 vs 1.1, P = 0.7 and 1.9 vs 2.4, P = 0.3, respectively). There were only minor complications, and these were not significantly different between the groups.. Topical anaesthesia with prilocaine-lidocaine cream significantly reduced pain at transrectal probe insertion and during the biopsy procedure.

Topics: Adult; Aged; Aged, 80 and over; Anesthetics, Combined; Anesthetics, Local; Biopsy, Needle; Double-Blind Method; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Ointments; Pain; Pain Measurement; Pain, Postoperative; Prilocaine; Prospective Studies; Prostate; Prostatic Neoplasms; Ultrasonography, Interventional

Topics: Anesthetics, Combined; Biopsy, Needle; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Ointments; Pain; Prilocaine; Prostate; Prostatic Neoplasms; Randomized Controlled Trials as Topic