Efficacy and safety of peri-prostatic local anaesthetic injection in trans-rectal biopsy of the prostrate: A prospective randomised study

Objective: To assess the efficacy and safety of periprostatic lignocaine injection in trans-rectal ultrasound (TRUS) -guided biopsy of the prostate gland. Methods: Ninety- six men (mean age 65 years, range 47–74) undergoing TRUS biopsy were randomised into the local anaesthetic (LA) or placebo group. Six to twelve biopsy cores were taken, the majority being 10 cores. Patients were asked to fill in the expected pain score on a visual analogue scale (VAS) prior to the procedure. They also completed the actual pain experienced on VAS after the biopsy. The incidence of complications was documented. Results: The age, mean prostate specific antigen (PSA) were comparable in both groups. The expected pain score was also comparable (5.2 ± 1.6 in LA, 5.0 ± 1.4 in Placebo). In the LA group, the mean actual pain score was 3.0 ± 1.8 and in the placebo group it was 6.5 ± 2.2 (P = 0.0001). When patients were asked whether they would undergo the procedure again in the same way, 100% of the LA group and only 64% of the placebo group responded ‘yes' (P=0.002 using Fisher's test). The complication rates were not significantly different between the two groups. Conclusion: Peri-prostatic injection of local anaesthetic is safe and reduces discomfort significantly, and should be routinely offered to patients