Does combined perianal-intrarectal lidocaine-prilocaine cream and periprostatic nerve block provide better pain relief than periprostatic nerve block alone during transrectal ultrasound guided prostate biopsy?

Abstract

Objective: To compare the efficacy of combined perianal-intrarectal (PI) lidocaine-prilocaine (LP) cream (EMLA cream) and periprostatic nerve block (PNB) with PNB alone during transrectal ultrasound guided prostate biopsy (TRUS Bx).

Patients & Methods: This is a prospective study without blinding. All patients attending Queen Mary Hospital (QMH) and Tung Wah Hospital (TWH) for TRUS Bx were recruited. LP cream with PNB was used in QMH patients, and PNB only in TWH patients. Visual analogue scale (VAS) scores were collected during probe insertion, peri-prostatic nerve block and biopsy taking.

Results: From 7/2012 to 4/2013, 246 patients were recruited, 162 from QMH and 84 from TWH. The mean VAS during probe insertion, peri-prostatic block and biopsy taking were 2.31, 2.34 and 3.14 respectively in combination arm and 2.87, 2.50 and 3.90 respectively in PNB only arm. Only the difference in VAS during biopsy taking reached statistical significance (p = 0.037). Subgroup analysis of patients aged below 70 revealed significant differences in VAS during probe insertion and biopsy taking, ie. probe insertion (2.37 vs 3.29, p = 0.046), peri-prostatic block (2.29 vs 2.67, p = 0.368) and biopsy taking (3.25 vs 4.29, p = 0.024) in combination arm and in PNB respectively.

Conclusion: EMLA cream in addition to peri-prostatic nerve block is superior to peri-prostatic nerve block alone, especially for patients aged below 70.