Timing interval from peri-prostatic block to biopsy impacts procedural pain

Area of Science:

• Urology
• Pain Management
• Medical Procedures

Background:

• Transrectal ultrasound-guided prostate biopsies (TRUS-bx) are associated with patient discomfort.
• Peri-prostatic lidocaine injection is commonly used to mitigate pain during TRUS-bx.

Purpose of the Study:

• To compare visual analog scale (VAS) pain scores in patients undergoing TRUS-bx with a 2-minute versus a 10-minute delay of peri-prostatic lidocaine injection.

Main Methods:

• Eighty patients undergoing standard 12-core TRUS-bx were prospectively randomized into four groups based on injection site (bibasilar or bibasilar plus apical) and delay time (2 or 10 minutes).
• Pain was assessed using the VAS (0-10) at multiple intervals: probe insertion, after each core, and post-procedure.
• The primary outcome was the baseline-adjusted mean VAS score across all 12 cores.

Main Results:

• The 10-minute delay group reported significantly lower baseline-adjusted mean VAS pain scores compared to the 2-minute delay group (mean difference: -0.9, p=0.025).
• This significant pain reduction was observed across all biopsy subsets (biopsies 1-3, 4-6, 7-9, and 10-12) in the 10-minute delay group (all p ≤ 0.043).

Conclusions:

• Extending the waiting time for prostate biopsies after lidocaine injection from 2 to 10 minutes effectively lowers patient-reported pain.
• A 10-minute delay in peri-prostatic lidocaine administration is recommended to improve patient comfort during TRUS-bx.