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Prospective comparison among three intrarectal anesthetic treatments combined with periprostatic nerve block during transrectal ultrasonography-guided prostate biopsy

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Abstract

Background

Recent trends in prostate biopsy analgesia suggest a combination anesthetic to provide better pain relief than periprostatic nerve block (PPNB) alone. This study aimed to demonstrate the efficacy and safety of three intrarectal local anesthesia (IRLA) combined with PPNB in patients undergoing transrectal ultrasonography (TRUS)-guided prostate biopsy.

Methods

In this prospective, randomized study, 120 prostate biopsy patients were equally divided into four IRLA groups: group 1 (placebo) received simple lubrication; group 2 received 2% lidocaine gel; group 3 received 100 mg indomethacin suppository and group 4 received 5% prilocaine/lidocaine (EMLA) cream. PPNB with 2% lidocaine was applied in all groups. A ten-point visual analog scale evaluated both pain associated with the probe insertion and pain associated with prostate sampling. Adverse effects or complications due to anesthesia during and after the procedure were documented.

Results

Compared with group 1, groups 3 and 4 had significantly lower pain scores at both probe insertion and prostate sampling while group 2 showed no significant differences at both pain scores. Moreover, group 4 showed significantly lower pain scores at probe insertion compared to group 3, while no significant difference was observed at prostate sampling. Mild complications were observed in all groups with no significant difference in the incidence of complications between groups.

Conclusion

Intrarectal application of EMLA cream is a more efficient pain reduction than either 2% lidocaine gel or 100 mg indomethacin suppository when applied combined with PPNB. This combination represents an effective option of pain relief for patients undergoing TRUS-guided prostate biopsy.

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Acknowledgements

Special thanks to Dr. DJ Pacheco Bouthillier for his valuable help in the design of the study and support in the statistical analysis.

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Authors and Affiliations

  1. Urology Department, Central Military Hospital, Mexico City, Mexico

    R. A. Valdez-Flores, J. G. Campos-Salcedo, J. J. Torres-Gomez & A. Sedano-Lozano

  2. Research Unit, Regional Military Hospital, San Luis Potosí, Mexico

    J. Parés-Hipólito

  3. Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands

    L. M. Shelton

  4. Research Center Applied to Public Health, School of Medicine, Autonomous University of Sinaloa, Campus 2. Av. Cedros y Calle Sauces. Fracc. Los Fresnos, 80019, Culiacan, Sinaloa, Mexico

    A. Canizalez-Román & M. A. Valdez-Flores

  5. The Women’s Hospital, Secretariat of Health, 80127, Culiacan, Sinaloa, Mexico

    A. Canizalez-Román

Authors
  1. R. A. Valdez-Flores
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  2. J. G. Campos-Salcedo
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  3. J. J. Torres-Gomez
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  4. A. Sedano-Lozano
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  5. J. Parés-Hipólito
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  6. L. M. Shelton
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  7. A. Canizalez-Román
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  8. M. A. Valdez-Flores
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Corresponding author

Correspondence to M. A. Valdez-Flores.

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Valdez-Flores, R.A., Campos-Salcedo, J.G., Torres-Gomez, J.J. et al. Prospective comparison among three intrarectal anesthetic treatments combined with periprostatic nerve block during transrectal ultrasonography-guided prostate biopsy. World J Urol 36, 193–199 (2018). https://doi.org/10.1007/s00345-017-2136-z

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  • DOI: https://doi.org/10.1007/s00345-017-2136-z

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