Comparison between ultrasound-guided and digital-guided anesthesia before prostatic biopsy

Our target in this study is to evaluate the efficacy of ultrasound (US)-guided anesthesia in comparison it to the digital-guided one, considering pain and discomfort reduction, during prostate biopsy.

We analyzed 150 patients that underwent prostate biopsy between March 2011 and January 2012; conditions to enter the sample were: elevated PSA levels and/or psa ratio free/total less than 15% and/or detection of alteration via ultrasound examination and/or a positive outcome of a digital rectal examination. Patients were randomized into two groups. In 75 patients (group A) was performed local US-guided anesthesia with a dose of 10 ml of mepivacaine 1%, in the other 75 patients (group B) a local digital-guided anesthesia was performed, again with an equal dose of 10 ml of mepivacaine 1%. After the biopsy patients were kept under observation for two hours, after that they were asked to provide description of the pain experienced during biopsy, using a 10-point visual analog scale (visual analogue scale; 0 for no pain, 10 for excruciating pain).

In group A, 49 patients scored a VAS value of zero, 23 a value of 1 and 2 a value of 3. On the other side, in group B, 9 patients scored a VAS value of 1, 36 a value of 2, 28 a value of 3 and 2 a value of 4. In comparison patients in group A scored VAS values statistically lower than patients in group B (t student test, p < 0.01).

The ultrasound-guided prostatic anesthesia is preferable to the digital-guided, because it considerably reduce the pain related to this procedure.