Objective: The study aims to review the current evidence to determine the efficiency and safety of intrarectal topical anesthesia (ITA) for transrectal ultrasound-guided prostate biopsy. Materials and Methods: A comprehensive search of the literature was performed using Medline, Embase and Cochrane central register of controlled trials. All randomized controlled trials (RCTs) comparing the efficacy and safety of periprostatic nerve block (PNB), ITA, and PNB combined with ITA were included. The mean pain scores after the biopsy procedure, the mean pain scores after the probe insertion and adverse events were evaluated. Results: Thirty-2 RCTs were identified in the meta-analysis. ITA could significantly reduce pain during probe insertion compared to control and placebo. The PNB group had less pain after the prostate biopsy than the ITA group. PNB combined with ITA could significantly reduce pain during the biopsy procedure compared to ITA alone. No significant differences were found in adverse events in ITA versus control, ITA versus placebo, and ITA versus PNB. Conclusions: ITA could reduce pain after probe insertion and pain after biopsy although it was inferior to PNB in reducing pain during prostate biopsy. ITA combined with PNB was more effective than ITA alone. In addition, it was safe to perform ITA for prostate biopsy.

Keywords:
Anesthesia, Biopsy, Intrarectal topical anesthesia, Prostate cancer
1.
Mottet N, Bellmunt J, Bolla M, Briers E, Cumberbatch MG, De Santis M, et al: EAU--ESTRO-SIOG guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol 2017; 71: 618–629.
2.
Tiong HY, Liew LC, Samuel M, Consigliere D, Esuvaranathan K: A meta-analysis of local anesthesia for transrectal ultrasound-guided biopsy of the prostate. Prostate Cancer Prostatic Dis 2007; 10: 127–136.
3.
Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ: Assessing the quality of reports of randomized clinical trials: is blinding necessary. Control Clin Trials 1996; 17: 1–12.
4.
Giannarini G, Autorino R, Valent F, Mogorovich A, Manassero F, De Maria M, et al: Combination of perianal-intrarectal lidocaine-prilocaine cream and periprostatic nerve block for pain control during transrectal ultrasound guided prostate biopsy: a randomized, controlled trial. J Urol 2009; 181: 585–591; discussion 591–593.
5.
Gurbuz C, Canat L, Bayram G, Gokhan A, Samet G, Caskurlu T: Visual pain score during transrectal ultrasound-guided prostate biopsy using no anaesthesia or three different types of local anaesthetic application. Scand J Urol Nephrol 2010; 44: 212–216.
6.
Buckley MR, Bryant NJ, Brown JA, Tiwari P, Cooperberg PL, Wong AD: Tolerance of local anesthetic for transrectal ultrasound-guided prostate biopsy: our experience and a literature review. Can Assoc Radiol J 2006; 57: 169–174.
7.
Stirling BN, Shockley KF, Carothers GG, Maatman TJ: Comparison of local anesthesia techniques during transrectal ultrasound-guided biopsies. Urology 2002; 60: 89–92.
8.
Trucchi A, De Nunzio C, Mariani S, Palleschi G, Miano L, Tubaro A: Local anesthesia reduces pain associated with transrectal prostatic biopsy. A prospective randomized study. Urol Int 2005; 74: 209–213.
9.
Kandirali E, Ulukaradag E, Uysal B, Serin E, Semercioz A, Metin A: Is only perianal anesthesia with lidocaine-prilocaine cream sufficient to decrease the pain during transrectal ultrasound-guided prostate biopsy? A prospective randomized study. Urol Int 2009; 82: 262–265.
10.
Galosi AB, Minardi D, Dell’atti L, Yehia M, Muzzonigro G: Tolerability of prostate transrectal biopsies using gel and local anesthetics: results of a randomized clinical trial. J Endourol 2005; 19: 738–743.
11.
Issa MM, Bux S, Chun T, Petros JA, Labadia AJ, Anastasia K, et al: A randomized prospective trial of intrarectal lidocaine for pain control during transrectal prostate biopsy: the Emory University experience. J Urol 2000; 164: 397–399.
12.
Yurdakul T, Taspinar B, Kilic O, Kilinc M, Serarslan A: Topical and long-acting local anesthetic for prostate biopsy: a prospective randomized placebo-controlled study. Urol Int 2009; 83: 151–154.
13.
Raber M, Scattoni V, Roscigno M, Rigatti P, Montorsi F: Perianal and intrarectal anaesthesia for transrectal biopsy of the prostate: a prospective randomized study comparing lidocaine-prilocaine cream and placebo. BJU Int 2005; 96: 1264–1267.
14.
Raber M, Scattoni V, Roscigno M, Dehò F, Briganti A, Salonia A, et al: Topical prilocaine-lidocaine cream combined with peripheral nerve block improves pain control in prostatic biopsy: results from a prospective randomized trial. Eur Urol 2008; 53: 967–973.
15.
Adamakis I, Mitropoulos D, Haritopoulos K, Alamanis C, Stravodimos K, Giannopoulos A: Pain during transrectal ultrasonography guided prostate biopsy: a randomized prospective trial comparing periprostatic infiltration with lidocaine with the intrarectal instillation of lidocaine-prilocain cream. World J Urol 2004; 22: 281–284.
16.
De Maria M, Mogorovich A, Giannarini G, Manassero F, Selli C: Lidocaine-prilocaine administration during transrectal ultrasound-guided prostatic biopsy: a randomized, single-blind, placebo-controlled trial. J Endourol 2006; 20: 525–529.
17.
Leung SY, Wong BB, Cheung MC, Ho KL, Lee FC, Tam PC: Intrarectal administration of lidocaine gel versus plain lubricant gel for pain control during transrectal ultrasound-guided extensive 10-core prostate biopsy in Hong Kong Chinese population: prospective double-blind randomised controlled trial. Hong Kong Med J 2006; 12: 103–107.
18.
Argüelles SE, Congregado Ruiz CB, Conde Sánchez JM, Ruiz Zafra V, Medina López RA, Campoy Martínez P: [Ultrasound guided transrectal prostatic biopsy and pain. Prospective randomized study comparing lubricant gel, lidocaine gel, and anesthetic blockage of the neurovascular bundles with 1% lidocaine]. Arch Esp Urol 2008; 61: 579–590.
19.
Chang SS, Alberts G, Wells N, Smith JA Jr, Cookson MS: Intrarectal lidocaine during transrectal prostate biopsy: results of a prospective double-blind randomized trial. J Urol 2001; 166: 2178–2180.
20.
Desgrandchamps F, Meria P, Irani J, Desgrippes A, Teillac P, Le Duc A: The rectal administration of lidocaine gel and tolerance of transrectal ultrasonography-guided biopsy of the prostate: a prospective randomized placebo-controlled study. BJU Int 1999; 83: 1007–1009.
21.
Fink KG, Gnad A, Meissner P, Götschl R, Schmeller NT: Lidocaine suppositories for prostate biopsy. BJU Int 2005; 96: 1028–1030.
22.
Sataa S, Ramzi M, Mohamed C, Imed BS, Sami BR, Ghassen H, et al: [Local anesthesia in transrectal ultrasound-guided prostate biopsy: apical periprostatic nerve block versus endorectal lidocaine gel. A randomized controlled trial of 100 patients]. Tunis Med 2010; 88: 217–222.
23.
Tobias-Machado M, Verotti MJ, Aragao AJ, Rodrigues AO, Borrelli M, Wroclawski ER: Prospective randomized controlled trial comparing three different ways of anesthesia in transrectal ultrasound-guided prostate biopsy. Int Braz J Urol 2006; 32: 172–179; discussion 179–180.
24.
Goluza E, Hudolin T, Kastelan Z, Peric M, Murselovic T, Sosic H: Lidocaine suppository for transrectal ultrasound-guided biopsy of the prostate: a prospective, double-blind, randomized study. Urol Int 2011; 86: 315–319.
25.
Lynn NN, Collins GN, Brown SC, O’Reilly PH: Periprostatic nerve block gives better analgesia for prostatic biopsy. BJU Int 2002; 90: 424–426.
26.
Song SH, Kim JK, Song K, Ahn H, Kim CS: Effectiveness of local anaesthesia techniques in patients undergoing transrectal ultrasound-guided prostate biopsy: a prospective randomized study. Int J Urol 2006; 13: 707–710.
27.
Başar H, Başar MM, Ozcan S, Akpinar S, Başar H, Batislam E: Local anesthesia in transrectal ultrasound-guided prostate biopsy: EMLA cream as a new alternative technique. Scand J Urol Nephrol 2005; 39: 130–134.
28.
Mallick AS, Soloway MS, Vaidya A, Lynne CM, Gheiler EL: Local anesthesia for ultrasound guided prostate biopsy: a prospective randomized trial comparing 2 methods. J Urol 2001; 166: 1343–1345.
29.
Kravchick S, Peled R, Ben-Dor D, Dorfman D, Kesari D, Cytron S: Comparison of different local anesthesia techniques during TRUS-guided biopsies: a prospective pilot study. Urology 2005; 65: 109–113.
30.
Mallick S, Humbert M, Braud F, Fofana M, Blanchet P: Local anesthesia before transrectal ultrasound guided prostate biopsy: comparison of 2 methods in a prospective, randomized clinical trial. J Urol 2004; 171: 730–733.
31.
Mallick S, Braud F, Fofana M, Humbert M, Clervil M, Blanchet P: Which anaesthesia should be recommended for prostate biopsy? West Indian Med J 2005; 54: 135–138.
32.
Matlaga BR, Lovato JF, Hall MC: Randomized prospective trial of a novel local anesthetic technique for extensive prostate biopsy. Urology 2003; 61: 972–976.
33.
Rodriguez A, Kyriakou G, Leray E, Lobel B, Guillé F: Prospective study comparing two methods of anaesthesia for prostate biopsies: apex periprostatic nerve block versus intrarectal lidocaine gel: review of the literature. Eur Urol 2003; 44: 195–200.
34.
Szlauer R, Gotschl R, Gnad A, Meissner P, Paras L, Schmeller NT, et al: Comparison of lidocaine suppositories and periprostatic nerve block during transrectal prostate biopsy. Urol Int 2008; 80: 253–256.
35.
von Knobloch R, Weber J, Varga Z, Feiber H, Heidenreich A, Hofmann R: Bilateral fine-needle administered local anaesthetic nerve block for pain control during TRUS-guided multi-core prostate biopsy: a prospective randomised trial. Eur Urol 2002; 41: 508–514; discussion 514.
36.
Bingqian L, Peihuan L, Yudong W, Jinxing W, Zhiyong W: Intraprostatic local anesthesia with periprostatic nerve block for transrectal ultrasound guided prostate biopsy. J Urol 2009; 182: 479–483; discussion 483–484.
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2017
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