Periprostatic nerve block (PNB) alone vs PNB combined with an anaesthetic-myorelaxant agent cream for prostate biopsy: a prospective, randomized double-arm study.

OBJECTIVE

To compare the efficacy of periprostatic nerve block (PNB) alone vs PNB combined with the local administration of a 1.5% lidocaine/0.3% nifedipine cream (Antrolin, Bracco, Milan, Italy).

PATIENTS AND METHODS

In a prospective, randomized, double-arm study, 200 patients were randomized to receive PNB alone (group A, 100) or PNB combined with a previous administration of the topical anaesthetic Antrolin (group B, 100). The PNB was applied by infiltrating bilaterally a solution of 5 mL lidocaine 1% and naropine 0.75%. Patients were asked to complete visual analogue scale (VAS) questionnaire (0-10) to score pain and discomfort during probe insertion (VAS1), PNB (VAS2), cores (VAS3), 30 min after biopsy (VAS4), the evening of the procedure (VAS5), and the day after biopsy (VAS6).

RESULTS

Pain during probe insertion in group B was significantly less than in group A (VAS1 0.82 vs 2.9; P < 0.001). Pain during periprostatic infiltration was also lower in group B than group A (VAS2 1.4 vs 3.48; P < 0.001). Pain control was similar during biopsy in the two groups (VAS3 1.28 vs 1.2; P = 0.69). The pain scored at VAS4 was significantly less in group B (0.7 vs 1.86, P < 0.001), as was VAS5 (0.68 vs 1.3, P < 0.001). There was no difference in pain perception the day after biopsy (VAS6, 0.32 vs 0.22, P = 0.14).

CONCLUSIONS

Antrolin placed with PNB is better than PNB alone in reducing pain and discomfort during transrectal-ultrasonography guided prostate biopsy.