Periprostatic local anesthesia with pudendal block for transperineal ultrasound-guided prostate biopsy: a randomized trial.

OBJECTIVES: To investigate the effectiveness of adding pudendal block to periprostatic anesthesia for transperineal ultrasound-guided needle prostate biopsy. METHODS: A total of 150 patients were randomized to receive periprostatic anesthesia (group 1, n = 75) or combination of periprostatic anesthesia and bilateral pudendal block (group 2, n = 75). Visual analog scale was used to evaluate discomfort at each of the following stages: anesthetic infiltration, probe insertion, biopsy punctures, and 1 hour after biopsy. RESULTS: The overall cancer detection rate was 34.7% for the entire cohort. Injection of the local anesthetic agent was significantly more painful in group 2 (combined periprostatic and pudendal block). However, this group showed statistically significantly better pain control throughout the probe insertion, biopsy punctures, and at 1 hour after biopsy. The mean pain score of the whole procedure, calculated by averaging the pain scores at all 4 steps, was 2.41 +/- 1.01 and 1.83 +/- 0.65 in group 1 and 2, respectively (P <.001). Minor and transient complications were observed in both groups with similar frequency with the exception of penile and scrotal numbness that was reported only by patients from group 2, and in all cases resolved without treatment within 8 hours. CONCLUSIONS: A combination of pudendal and periprostatic nerve block is a safe, effective, and useful technique that is well tolerated by the patients and improves pain reduction during transperineal prostate biopsy compared with the periprostatic anesthesia only, with no alteration in the severe complication rates.