Comparison of two periprostatic nerve blockade techniques for transrectal ultrasound-guided prostate biopsy: bilateral basal injection and single apical injection.

ABSTRACT

OBJECTIVES: To investigate the effectiveness of a periprostatic nerve blockade technique that relies on a single apical injection of lidocaine. We compared it with bilateral injections at the base of the prostate to determine the effectiveness of pain control and to compare the technical aspects during transrectal ultrasound-guided prostate biopsy. METHODS: The study included patients who had elected to undergo transrectal ultrasound-guided prostate needle biopsy. The patients were divided into 2 groups according to the anesthesia technique they would receive. In the bilateral basal injection group (n = 60), 2 injections of 5 mL lidocaine were administered just lateral to the junction between the base of the prostate and the seminal vesicles on both sides. In the single apical injection group (n = 57) 5 mL of lidocaine was injected at the apex of the prostate to provide the distribution of lidocaine toward the base of the prostate under Denonvilliers fascia. RESULTS: Both techniques were effective regarding pain control, with better results in the single apical injection group. The mean numeric rating scale score was 2.46 +/- 1.03 and 2.01 +/- 1.02 in the bilateral basal injection and single apical injection groups, respectively (P = .01). CONCLUSIONS: The results of this randomized prospective study suggest that both the single apical injection and the bilateral basal injection techniques are effective in terms of pain prevention during transrectal-ultrasound-guided prostate biopsy. The main advantage of the single apical injection technique is its ease of use and the requirement for one half the amount of local anesthetic agent.