[Peri-prostatic nerve block at the level of the apex versus intrarectal lidocaine gel].

Introduction: After a review of the contradictory results of studies concerning periprostatic nerve block, the authors decided to prospectively evaluate the efficacy of periprostatic nerve block in the apex compared to the use of endorectal lidocaine gel.
Methods: From January 2001 to January 2002, 110 patients underwent prostatic biopsies. Patients were randomized to receive 10 cc of 2% lidocaine gel in the endorectal (group 1), or 10 cc of 1% lidocaine solution injected into the apex to induce bilateral periprostatic nerve block (group 2). Pain was evaluated by a 10-point linear visual analogue pain scale (VAS), and a 5-point digital visual scale (DVS).
Results: 96 patients were included in the study: 43 in group 1 and 53 in group 2. The mean pain score on the VAS was 2.76 +/- 1.69 and 1.73 +/- 1.26 for groups 1 and 2, respectively (p = 0.001). The DVS score was 2.26 +/- 0.82 and 1.62 +/- 0.56 for groups 1 and 2, respectively (p < 0.001). No significant difference was observed for mean age (p = 0.348), prostatic volume (p = 0.899), PSA level (p = 0.932) and complications between the two groups. The number of biopsies per patient was significantly higher in group 2 (p = 0.006), with significantly lower pain scores on each of the 2 scales.
Conclusions: Apical periprostatic nerve block ensured better pain control during transrectal prostate biopsy, compared to the use of endorectal lidocaine gel, with no increase in the complication rate.