Local anesthesia for transperineal prostate biopsy performed under sedation: effects on intraoperative and postoperative narcotic use.

PURPOSE

To investigate whether patients undergoing sedated prostate biopsies benefit from administration of local anesthetic.

MATERIALS AND METHODS

880 transperineal prostate biopsies were done under sedation at our institution between November 2022 and December 2023. We assessed the effect of bupivacaine on pain severity during post-anesthesia care unit (PACU) stay, use of narcotics in PACU, length of PACU stay, and urinary retention. Multivariable logistic regression was used for pain score and narcotics use outcomes; multivariable linear regression for PACU length of stay and intraoperative propofol use; and univariable logistic regression for urinary retention.

RESULTS

340 patients received bupivacaine, 334 did not. Ten patients (3.0%) who received bupivacaine and 30 (9.0%) who did not had maximum PACU pain scores ≥ 5 (95% CI 3.5%-12%, p < 0.001). Nine (2.6%) in the bupivacaine group and 31 (9.3%) in the no-bupivacaine group received narcotics (95% CI 4.4%-13%, p < 0.001), indicating significantly higher risk of needing narcotics among patients not receiving bupivacaine. We found no evidence of an effect of bupivacaine use on PACU LOS (β -0.08 h, 95% CI -0.20-0.03, p = 0.15) or urinary retention (OR 0.78, 95% CI 0.19-2.99, p = 0.7). Bupivacaine was associated with less intraoperative fentanyl (IRR 0.67, 95% CI 0.50-0.89) but more propofol (adjusted difference 48 mg, 95% CI 25-71, p < 0.001).

CONCLUSION

Local anesthetic at the time of sedated transperineal prostate biopsy reduces both intraoperative and postoperative narcotic use and causes less post-procedure pain. A randomized study to confirm this finding is warranted.