Prospective randomized controlled trial comparing three different ways of anesthesia in transrectal ultrasound-guided prostate biopsy.

PURPOSE To make an objective controlled comparison of pain tolerance in transrectal ultrasound-guided prostatic biopsy using intrarectal topic anesthesia, injectable periprostatic anesthesia, or low-dose intravenous sedation. MATERIALS AND METHODS One hundred and sixty patients were randomized into 4 groups: group I, intrarectal application of 2% lidocaine gel; group II, periprostatic anesthesia; group III, intravenous injection of midazolam and meperidine; and group IV, control, patients to whom no sedation or analgesic was given. Pain was evaluated using an analogue pain scale graded from 0 to 5. Acceptance of a repetition biopsy, the side effects of the drugs and complications were also evaluated. RESULTS 18/20 (90%) and 6/20 (30%) patients reported strong or unbearable pain in the group submitted to conventional biopsy and topical anesthesia (p = 0.23, chi-square = 1.41); whereas those submitted to periprostatic blockade and sedation, severe pain occurred in only 2/60 (3%) patients (p < 0.001, chi-square = 40.19) and 3/60 (5%) patients (p < 0.001, chi-square = 33.34). Acceptance of repetition of the biopsy was present in only 45% of the patients submitted to conventional biopsy, 60% of those that were given topical anesthesia (p = 0.52, chi-square = 0.4), compared to 100% of those submitted to periprostatic anesthesia (p < 0.01, chi-square = 15.17), and 95% of those who were sedated (p < 0.001, chi-square = 25.97%). CONCLUSIONS Transrectal ultrasound-guided prostatic biopsy is an uncomfortable experience; however application of periprostatic blockade and intravenous analgesia are associated to higher tolerance of the exam and patient comfort. Low dose sedation by association of intravenous meperidine and midazolam is an emerging and safe outpatient option.