Archivio Italiano di Urologia e Andrologia 2016; 88, 4 308 ORIGINAL PAPER Transrectal ultrasound (TRUS) guided prostate biopsy: Three different types of local anesthesia Giuseppina Anastasi, Enrica Subba, Rosa Pappalardo, Luciano Macchione, Gioacchino Ricotta, Graziella Muscarà, Francesco Lembo, Carlo Magno Unit of Urology, Department of Human Pathology, University of Messina, Messina, Italy. Transrectal Ultrasound (TRUS) guided prostate biopsy is regarded as the gold standard for prostate cancer diagnosis. The majority of patients perceive TRUS-guided prostate biopsy as a physically and psychologically traumatic experience. We aimed to com- pare in this paper the efficacy of three different anesthesia techniques to control the pain during the procedure. Materials and methods: 150 patients who underwent transrec- tal ultrasound (TRUS) guided prostate biopsy were randomly divided into three groups. Group A included 50 patients who received one hour before the procedure a mixture of 2.5% lidocaine and 2.5% prilocaine, Group B: 50 patients who received intrarectal local anesthetic administration (lidocaine 5 ml 10%) and lidocaine local spray 15 % and Group C included 50 patients who received periprostatic block anesthe- sia (lidocaine 10 ml 10%). Visual analogue scale (VAS) of patients in different groups was evaluated at the end of the biopsy and 30 minutes after the procedure. Results: The VAS of patients in Group A was 1.32 ± 0.65 (VAS I) and 2.47 ± 0.80 (VAS II). In group B the VAS of patients was 1.09 ± 0.47 (VAS I) and 1.65 ± 0.61 (VAS II). In group C the VAS of patients was 2.63 ± 0.78 (VAS I) and 1.70 ± 0.85 (VAS II). There was no statistically significant difference in term of VAS I between group A and B. A statistically significant difference was determined in terms of VAS II between group A and B. There was no statistically significant difference in term of VAS between group B and C. Conclusions: The most effective of the three methods for pain control we used was intrarectal local anesthetic administra- tion and lidocaine local spray 15% that enables an ideal patient comfort. KEY WORDS: Biopsy; Local anesthesia; Pain control; Prostate. Submitted 15 November 2016; Accepted 15 December 2016 Summary No conflict of interest declared. sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such dam- age” (2). Two factors are usually responsible for pain dur- ing transrectal prostate biopsy: anal pain due to ultra- sound probe, that causes pressure and stretching of mus- cle fibers, and pain at insertion of the needle through the prostate (3). All of the pain-rating scales are reliable and valid. The well-known visual analogue scale (VAS) and numeric rating scale (NRS) for assessment of pain inten- sity agree well and are equally sensitive in assessing acute pain after surgery, and they are both superior to a four- point verbal categorical rating scale (VRS). Early studies conducted on sextant biopsy without anes- thesia showed that 65% to 90% of patients reported dis- comfort (1) and 19% would not agree to undergo it again without some form of anesthesia. Various kinds of local anesthesia have been used before TRUS-guided prostate biopsy, but there is no agreement about the most effec- tive one. TRUS-guided biopsy is commonly performed with intrarectal local anesthetic (IRLA), but one study has shown that > 50% of patients reported moderate-to- intolerable pain even with intrarectal lidocaine applica- tion before the procedure (4). The most commonly used anesthetic is lidocaine either in gel suspension or as an injectable preparation (periprostatic nerve block - PPNB) (5) although there is no strong evidence to recommend the different types of anesthetics that may be used. Some authors doesn’t use any types of anesthetics during trans- rectal prostate biopsy. Aim of our study was to compare the efficacy of three types of anesthesia methods for a painless transrectal ultrasound (TRUS) guided prostate biopsy. MATERIALS AND METHODS 150 patients who underwent transrectal ultrasound (TRUS) guided prostate biopsy (12 cores) were random- ly divided into three groups of 50. Group A included 50 patients who receive one hour before mixture of 2.5% lidocaine and 2.5% prilocaine, Group B included 50 patients who received intrarectal local anesthetic admin- istration (lidocaine 5 ml 10%) and lidocaine local spray 15% and Group C included 50 patients who received periprostatic block anesthesia (lidocaine 10 ml 10%). After transrectal ultrasound examination, assessing the DOI: 10.4081/aiua.2016.4.308 Presented at 20 th National Congress SIEUN, Sciacca 2016 INTRODUCTION Prostate cancer is the second leading cause of cancer death behind only lung cancer with more than 180.000 new cases/year and 25.000 deaths per year. Transrectal Ultrasound (TRUS) guided prostate biopsy is regarded as the gold standard for prostate cancer diagnosis as demonstrated by recent studies. The majority of patients perceive TRUS-guided prostate biopsy as a physically and psychologically traumatic experience (1). The International Association for the Study of Pain has offered the following definition of pain: “Pain is an unpleasant