OBJECTIVES: To introduce two forms of
anesthesia and compare them with standard
local anesthesia techniques. METHODS: A total of 114 consecutive patients underwent
prostate needle biopsy. The patients were sequentially
randomized to receive different kinds of
anesthesia: 2%
rectal lidocaine gel, 40%
dimethyl sulfoxide (DMSO) with
lidocaine, perianal injection of 1%
lidocaine, or periprostatic
nerve block.
Pain perception was separately assessed for probe insertion and
biopsies using a
visual pain analog score. One-way
analysis of variance was used to compare the data scale among the four groups. A
linear regression model was used to define the
independent variables that predicted the level of
pain. RESULTS: The groups were similar in terms of age,
prostate-specific antigen levels,
digital rectal examination findings,
prostate volume,
pain tolerance,
biopsy time, and number of cores taken. The lowest
pain scores for probe insertion were for the perianal injection and DMSO/
lidocaine groups (0.89 and 1.38, respectively). The difference between these scores and those for the other two groups was
statistically significant (P <0.001).
Pain perception during
biopsy did not differ significantly among the DMSO/
lidocaine, perianal, or periprostatic groups and was greatest in the
lidocaine gel group (4.147; P <0.001). We did not observe any
statistically significant correlation between the
pain level during probe insertion and
biopsy and
pain tolerance (P = 0.514 and P = 0.788, respectively). The
anesthesia type was the strongest single predictor of the
pain level during
biopsy (P <0.001). CONCLUSIONS: The use of 40% DMSO with
lidocaine instilled into the
rectal vault for 10 minutes avoids any need for injection and is capable of decreasing the discomfort or
pain experienced during probe insertion and
prostate biopsy comparable to the perianal and periprostatic protocols.
