Comparison of Pudendal Nerve Blockade, Tenoxicam Suppository and Rectal Lidocaine Gel Anesthesia for Transrectal Ultrasound- Guided Biopsy of the Prostate

Aim: We assessed the safety and efficacy of three different local anesthesia methods (pudendal nerve blockade, tenoxicam suppository and rectal lidocaine gel) before transrectal ultrasound (TRUS)-guided biopsy of the prostate in this study. Materials and Methods: In our prospective and controlled study, 136 consecutive patients were randomized into four groups: men in group 1 (n=41) received no anesthesia, group 2 (n=30) received intrarectal 10 cc 2% lidocaine gel 10 mins before biopsy, group 3 (n=31) received 20 mg tenoxicam suppository 30 mins before biopsy and pudendal nerve blockade was performed in group 4 (n=34) 10 mins before biopsy using 10 ml of 1% lidocaine. The patients were asked to grade the pain when TRUS probe was inserted and during the biopsy procedure using a 11-point linear visual analog scale (VAS) and their pain scores were noted. Results: There were statistically significant differences among four groups regarding the mean VAS scores during probe insertion (p=0.024) and biopsy (p=0.012). This significance was provided by the difference between the group 1 and 4 (p=0.015 for probe insertion and p=0.022 for biopsy with Tukey test). No statistically significant difference was found among the pain scores of group 1, 2 and, 3 during probe insertion and biopsy. Conclusions: Pudendal nerve blockade was effective in reducing pain both during the biopsy procedure and probe insertion, while suppository tenoxicam and rectal lidocaine gel had no significant anesthetic effect.