Pain relief from transrectal multicore prostate biopsy by periprostatic nerve block

von Knobloch, Rolf (Marburg)
Hofmann, Rainer (Marburg), Weber, Jost (Marburg)

Pain Relief from Transrectal Multicore Prostate Biopsy by Periprostatic Nerve Block: The
Marburg Procedure

Aims: Transrectal multi-core biopsies have a high sensitivity in diagnosing cancer of the
prostate, are of low risk, but can cause substantial discomfort with the need for high dose
systemic analgesics. In a prospective randomised trial we investigated the efficacy of
fine-needle administered local anaesthesia for bilateral prostate nerve block prior to
transrectal ultrasound (TRUS) guided prostate biopsy.
Method: 108 men suspected of having cancer of the prostate were randomised in receiving
bilateral prostate nerve block prior to biopsy or not, when having no history of previous
prostate biopsies (groups I & II, n = 68). In a third group (group III, n = 40) all patients
with previous biopsies taken exclusively received additional fine-needle administered local
anaesthesia. Patients without previous biopsies underwent a 10-core prostate biopsy, whereas
patients with previous biopsies taken received a 12-core TRUS-guided biopsy. Local anaesthesia
(10 - 20ml 1% Articain) was injected via TRUS-guidance with a 26-gauge needle
postero-laterally to the prostate capsule in the region of the neurovascular bundles.
Routinely 6ml 2% lidocaine gel (Instillagel®) was applied prior to the procedure in all
groups. All biopsies were performed by the same investigator (author R.v.K). Pain was
documented by the patient on a visualized analogue pain score of 1 to 10 (lowest to highest
imaginable pain). A written consent was obtained from all patients.
Results: In the randomised groups I and II without previous biopsies average pain score was
1.85 with vs. 3.29 without fine-needle administered bilateral nerve block (p smaller than 0.0001). In group
III of patients with previous biopsies taken the difference in the pain stated for the present
biopsy with local anaesthesia nerve block in comparison to the pain experienced with the
previous biopsy solely with transrectal lidocaine gel was also statistically highly
significant (1.71 vs. 4.59; p smaller than 0.0001). Pain relief was independent of the number of biopsy
cores taken. As the only complication prolonged rectal bleeding was seen in 1 case. Overall
cancer detection rate was 46% (50/108).
Conclusion: Fine-needle applied bilateral local anaesthesia nerve-block prior to multi-core
TRUS-guided prostate biopsy significantly reduces pain to acceptably low levels only causing
minor discomfort independent from the number of cores taken. This method has therefore become
a standard procedure at our institution. (Eur Urol 41 (2002): 508-14)