Open Access

ARTICLE

Timing interval from peri-prostatic block to biopsy impacts procedural pain

Ram A. Pathak¹, David D. Thiel¹, Alexander Parker², Michael G. Heckman³, Julia E. Crook³, Nancy N. Diehl³, Andrea Tavlarides², Scott W. Alford¹, Todd C. Igel¹

1 Department of Urology, Mayo Clinic, Jacksonville, Florida, USA
2 Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida, USA
3 Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida, USA
Address correspondence to Dr. David D. Thiel, Department of Urology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224 USA

Canadian Journal of Urology 2017, 24(3), 8795-8801.

Abstract

Introduction: To compare visual analog scale (VAS) pain scores between patients with a 2-minute versus 10-minute delay of peri-prostatic lidocaine injection prior to transrectal ultrasound-guided prostate biopsies (TRUS-bx).
Materials and methods: Eighty patients who underwent standard 12-core TRUS-bx by a single surgeon were prospectively randomized into four different treatment arms: bibasilar injection with a 2-minute delay, bibasilar injection plus a single apical injection with a 2-minute delay, bibasilar injection with a 10-minute delay, and bibasilar injection plus a single apical injection with a 10-minute delay. Patients were asked to report their level of pain on the VAS (0-10, with 10 indicating unbearable pain) at the following intervals: probe insertion (baseline), after each core, and post-procedure. The primary outcome measure was mean VAS score across all 12 cores minus baseline VAS score, which we refer to baseline-adjusted mean VAS score.
Results: Baseline-adjusted mean VAS score was significantly higher for the 2-minute delay group compared to the 10-minute delay group (mean: -0.7 versus -1.6, p = 0.025). Subset analysis of biopsies 1-3, 4-6, 7-9 and 10-12 also demonstrated higher baseline-adjusted mean VAS scores in the 2-minute delay group (all p ≤ 0.043).
Conclusions: Lower TRUS-bx VAS scores can be achieved by extending the time from lidocaine injection to onset of prostate biopsy from 2 to 10 minutes.

---

Keywords

---