A randomized prospective trial of intrarectal lidocaine for pain control during transrectal prostate biopsy: The Emory University experience

Purpose: We prospectively evaluated the safety and efficacy of intrarectal lidocaine gel as anesthesia during transrectal prostate biopsy. Materials and Methods: Of 63 consecutive men undergoing transrectal prostat e biopsy 50 who qualified were enrolled in this study. Indications for the procedure were an abnormal prostate on digital rectal examination and/or el evated serum prostate specific antigen. Patients were randomized into group 1-25 who received 10 cc of 2% intrarectal lidocaine 10 minutes before the procedure and group 2-25 controls. No narcotics, sedation or analgesia was given. Pain during biopsy was assessed using a 10-point linear visual analo g pain scale. Results: In groups 1 and 2 median patient age was 63 and 66 years (p = 0.13 9), and median prostate specific antigen was 6.04 (range 1.07 to 263) and 7 .24 (range 1.34 to 51.82) ng./ml. (p = 0.337). Digital rectal examination w as normal and abnormal in 17 and 15 group 1, and in 8 and 10 group 2 patien ts, respectively. Ultrasound showed a median prostate volume of 43.6 cc (ra nge 15.3 to 124) in group 1 and 40.3 (range 19.8 to 132) in group 2 (p = 0. 710), Final histological results revealed prostate cancer in 7 men (28%) in each group. The median pain score during transrectal prostate biopsy was 2 (range 1 to 5) and 5 (range 1 to 7) in groups 1 and 2, respectively (p = 0 .00001). No adverse events were noted. Conclusions: Intrarectal lidocaine gel is a simple, safe and efficacious me thod of providing satisfactory anesthesia in men undergoing transrectal pro state biopsy. We recommend its routine administration in all patients durin g this procedure.