Combination of intrarectal heated lidocaine gel and periprostatic nerve block for pain control during transrectal ultrasound-guided prostate biopsy: A prospective randomized trial

Purpose: To investigate the role of combined periprostatic nerve block (PNB) and intrarectal local anesthesia with heated lidocaine gel (ILAHL) in reducing pain during transrectal ultrasound (TRUS)-guided prostate biopsy, compared with PNB alone. Materials and Methods: We performed a prospective randomized trial with 140 participants who underwent systematic TRUS-guided, 12-core prostate biopsy from July 2021 to June 2022. These participants were divided into two groups. Before prostate biopsy, group 1 (n=70) received PNB and group 2 (n=70) received PNB combined intrarectal local anesthesia with 20 mL of heated (40 degrees C) 2% lidocaine gel. The primary outcome was pain score on a 0-10 visual analogue scale (VAS) at four time points (VAS A: during local anesthesia procedure, VAS B: during probe insertion, VAS C: during biopsy procedure, VAS D: 30 minutes after biopsy). The secondary outcome included adverse events during and after the procedure. Results: Mean pain scores were significantly lower in group 2 than in group 1 at VAS A (2.53 vs. 1.60, p=0.001) and VAS B (2.47 vs. 1.49, p<0.001). The mean VAS C pain score in group 2 was significantly less than in group 1 (3.07 vs. 2.20, p=0.001), while there was no significant difference in the mean VAS D pain score between two groups (1.06 vs. 0.89, p=0.318). There were no significant differences in the occurrence of complications in both groups. Conclusions: The combination of PNB and ILAHL provides more effective pain control than PNB alone without increase of complication rates in patients undergoing TRUS-guided prostate biopsy.