Comparison of local anesthesia techniques for pain control during transrectal ultrasound-guided prostate biopsy: A prospective randomized study

INTRODUCTION: Pain during transrectal ultrasound-guided (TRUS) prostate biopsy remains a major concern and may negatively affect patient tolerance and acceptance of the procedure. Various local anesthesia techniques have been developed to improve patient comfort. This prospective study aimed to evaluate the effectiveness and safety of two commonly used anesthetic approaches intrarectal local anesthesia (IRLA) and periprostatic nerve block (PNB) in patients undergoing prostate biopsy. PATIENTS AND METHODS: A prospective observational study was conducted involving all patients who underwent TRUS guided prostate biopsy. Two commonly used local anesthesia techniques were applied: intrarectal instillation of 15 mL of 2% lidocaine gel, and bilateral periprostatic injection of 5 mL of 1% lidocaine at the junction between the seminal vesicles and the prostate base. Based on randomization, patients were allocated to one of two groups. All patients underwent a standard 12-core biopsy, and pain levels were assessed immediately after the procedure using a visual analog scale (VAS) ranging from 0 to 10. RESULTS: We included 152 patients. The patients were divided into two groups (G1 and G2), with 76 patients in each group. Baseline demographic and clinical characteristics were comparable among the study groups. Pain assessment using the Visual Analog Scale (VAS) showed significantly lower scores in group 2 compared with group 1 at the time of insertion of ultrasound probe (p<0.001), after taking all the biopsy cores (p<0.001) and 2 hours thereafter (p<0.001). Post biopsy complication rates were low and comparable between the two groups. CONCLUSION: The local anesthesia technique used in G2 provided superior pain control during and after TRUS-guided prostate biopsy without increasing procedure-related complications. This approach appears to be a safe and effective option for improving patient comfort during prostate biopsy.