Intrarectal local anaesthesia matches periprostatic nerve block for pain reduction in prostate biopsy

The use of intrarectal local anaesthesia with heated lidocaine gel (IRLAH) can achieve similar levels of pain reduction as periprostatic nerve block (PNB) in patients undergoing transrectal ultrasound (TRUS)-guided prostate biopsy, reports a recent study.

Researchers conducted a randomized controlled noninferiority trial of 100 patients who underwent biopsy from August 2019 to July 2020. Half (n=50) of patients were given IRLAH with 20 mL 2% lidocaine heated to 40^oC, while the other half (n=50) received PNB. The study outcome was pain score on a 10-point visual analogue scale (VAS).

Mean VAS difference during local anaesthesia application between the two groups was –2.33 (95 percent confidence interval [CI], –2.66 to –1.79), in favour of IRLAH. That is, the noninvasive pain blocking method met noninferiority criteria, since the upper bound of its 95 percent CI range fell below a predefined margin. Moreover, IRLAH was also likely to meet superiority endpoints.

During biopsy, mean VAS difference was smaller at 0.3 (95 percent CI, –0.38 to 0.98). Though the difference was not statistically significant, the upper bound of the confidence range continued to be below prespecified inferiority thresholds, suggesting IRLAH was noninferior to PNB during biopsy.

Similarly, IRLAH met noninferiority checkpoints during probe insertion and 30 minutes after the procedure.

“IRLAH is an effective, noninvasive and safe method for alleviating prostate biopsy-related pain. Therefore, IRLAH appears to be a reasonable alternative to PNB for pain control during prostate biopsy,” the researchers said.