Perianal and intrarectal anaesthesia for transrectal biopsy of the prostate: a prospective randomized study comparing lidocaine-prilocaine cream and placebo

OBJECTIVES: To assess the effectiveness of perianal and intrarectal lidocaine-prilocaine cream for prostate biopsy. PATIENTS AND METHODS: In a prospective, randomized, double-blind, placebo-controlled study, 200 consecutive patients were randomized to receive 5 mL lidocaine-prilocaine cream or 5 mL placebo peri-anally and transrectally before transrectal ultrasonography (TRUS)-guided prostate needle biopsy (mean number of cores, 12). The men were asked to grade the pain when the TRUS probe was inserted and during the biopsy procedure using a 10-point linear visual analogue pain scale. RESULTS: At probe insertion, men in the anaesthetic group reported a significantly lower mean pain level than men in the placebo group (0.3 vs 1.6, P < 0.001). Men who had anaesthetic also reported less pain during biopsy punctures (1.8 vs 3.2, P < 0.001). Stratifying results by age, younger men (<67 years) benefited more from anaesthesia during probe insertion (0.9 vs 1.7; P = 0.04) and biopsy (1.8 vs 4.0, P < 0.001) than older men (1.0 vs 1.1, P = 0.7 and 1.9 vs 2.4, P = 0.3, respectively). There were only minor complications, and these were not significantly different between the groups. CONCLUSION: Topical anaesthesia with prilocaine-lidocaine cream significantly reduced pain at transrectal probe insertion and during the biopsy procedure.