Visual pain score during transrectal ultrasound-guided prostate biopsy using no anaesthesia or three different types of local anaesthetic application

Objectives: We report in this singlecenter study our results of a five-year experience in the administration of lidocaine spray (LS) during ultrasound-guided prostate biopsy (TPB). Material and Methods: Between August 2008 and July 2013 a total of 1022 consecutive male patients scheduled for TPB with elevate PSA (≥ 4 ng/ml) and (or) abnormal digital rectal and (or) suspect TRUS were considered eligible for the study. Each patient was treated under local anaesthesia with LS (10 gr/100 ml), applied two minutes before the procedure. TPB was performed with the patient in the left lateral decubitus using multi-frequency convex probe “end-fire”. Two experienced urologists performed a 14-core biopsy, as first intention. After the procedure each patient was given a verbal numeric pain scale (VNS). The evaluation was differentiated in two scales VNS: VNS 1 for the insertion of the probe and the manoeuvres associated, while VNS 2 only for the pain during needle’s insertion. Results: Pain scores were not statistically significant different with regard to the values of PSA and prostate gland volume. Pain score levels during probe insertion and biopsy were significantly different: the mean pain score according to VNS was 3.3 (2-8) in the first questionnaire (VNS1) (p < 0.001) and 2.1 (1-7) in the second one (VNS2) (p < 0.125). The 8.2% of cases referred severe or unbearable pain (score ≥ 7), 74% of patients referred no pain at all. Only 21 patients would not ever repeat the biopsy or would request a different type of anaesthesia, while 82% of them would repeat it in the same way. In only eight patients we have not been able to insert TRUS probe. Conclusions: Our pain score data suggest that LS provides efficient patient comfort during TPB reducing pain both during insertion of the probe and the needle. This non-infiltrative anaesthesia is safe, easy to administer, psychologically well accepted by patients and of low cost.

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Local anaesthetic for transrectal ultrasound-guided prostate biopsy: A prospective, randomised, double blind, placebo controlled study

European Urology Supplements ◽

10.1016/s1569-9056(03)80423-2 ◽

2003 ◽

Vol 2 (1) ◽

pp. 107

Author(s):

S.K. Addla ◽

A.A.B. Adeyoju ◽

G.D. Wemyss-Holden ◽

D. Neilson

Keyword(s):

Prostate Biopsy ◽

Local Anaesthetic ◽

Transrectal Ultrasound ◽

Controlled Study ◽

Ultrasound Guided ◽

Double Blind ◽

Double Blind Placebo

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The use of anaesthetic for transrectal ultrasound-guided prostate biopsy

Ultrasound ◽

10.1258/ult.2012.011051 ◽

2012 ◽

Vol 20 (2) ◽

pp. 98-103

Author(s):

K Jan ◽

S M Mak ◽

N Ley ◽

G Naisby ◽

D Chadwick

Keyword(s):

Prostate Cancer ◽

Prostate Biopsy ◽

Local Anaesthetic ◽

Gold Standard ◽

Transrectal Ultrasound ◽

Prostate Cancer Risk ◽

Complication Rates ◽

Ultrasound Guided ◽

National Guidelines ◽

The Impact

Background Transrectal ultrasound-guided prostate biopsy is the gold standard technique for detecting prostate cancer, undertaken routinely without the use of local anaesthetic (LA) in our institution. Current national guidelines provided by The NHS Prostate Cancer Risk Management Programme and the National Institute for Health and Clinical Excellence recommend and support the use of local anaesthetic injection as the most effective form of pain relief. Methods The primary aim of the study was to assess the impact of the introduction of national guidelines on the patient's pain perception of the procedure. Secondary aims were to compare the complication rates, i.e. bleeding, symptoms of infection and acceptance of a repeat procedure. A quantitative comparative study was performed. After the procedure, pain was evaluated using a questionnaire containing a visual analogue scale. A total of 75 consecutive patients’ prospective, anonymized questionnaire data, from those who were given LA, were compared with data from 75 patients who underwent prostate biopsy before the introduction of local anaesthetic. Data were analysed using two independent samples tests. Results The study findings supported the national clinical guidelines in the routine use of local anaesthetic during transrectal ultrasound-guided prostate biopsy: by demonstrating improvement in pain score, decreased reported discomfort and increased tolerability with no additional significant morbidity or complications. Conclusion The study has informed future policy and protocols by providing evidence based practice. Current working practice has changed to the routine offer of LA and is at present considered the gold standard.

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Multicentre clinical evaluation of the safety and performance of a simple transperineal access system for prostate biopsies for suspected prostate cancer: The CAMbridge PROstate Biopsy DevicE (CamPROBE) study

Journal of Clinical Urology ◽

10.1177/2051415820932773 ◽

2020 ◽

pp. 205141582093277

Author(s):

Vincent J Gnanapragasam ◽

Kelly Leonard ◽

Michal Sut ◽

Cristian Ilie ◽

Jonathan Ord ◽

...

Keyword(s):

United Kingdom ◽

Prostate Biopsy ◽

Local Anaesthetic ◽

Transrectal Ultrasound ◽

Procedure Time ◽

Ultrasound Guided ◽

Prostate Biopsies ◽

Patient Reported ◽

Biopsy Device ◽

Lead Site

Objectives: To report the prospective multicentre clinical evaluation of a first-in-man disposable device, Cambridge Prostate Biopsy Device, to undertake local anaesthetic outpatient transperineal prostate biopsies. Material and methods: Disposable single-use Cambridge Prostate Biopsy devices were manufactured based on a previous prototype. The lead site developed a user training course and disseminated the method to other sites. The Cambridge Prostate Biopsy Device (CamPROBE) was offered as an alternative to transrectal ultrasound guided biopsy to men due for a biopsy as part of their clinical management. Data on safety (infections and device performance), clinical utility, patient reported experience, biopsy quality and cancer detection were collected. Procedure time and local anaesthetic use was recorded in the lead site. The study was funded by a United Kingdom National Institute for Health Research (NIHR) i4i product development award. Results: A total of 40 patients were recruited (median age 69 y) across six sites; five sites were new to the procedure. Overall, 19/40 were first prostate biopsies and 21/40 repeat procedures. Both image-targeted and systematic biopsy cores taken. There were no infections, device deficiencies or safety issues reported. The procedure was well tolerated with excellent patient-reported perception and low pain scores (median of 3, scale 0–10). Histopathology quality was good and the overall cancer diagnosis rate (first diagnostic procedures) was 68% (13/19) and for significant cancers (⩾ histological Grade Group 2), 47% (9/19). In the lead centre (most experienced), median procedure time was 25 minutes, and median local anaesthetic use 11 ml ( n=17). Conclusions: Data from this device evaluation study demonstrate that the United Kingdom-developed Cambridge Prostate Biopsy Device/method for transperineal biopsies is safe, transferable and maintains high diagnostic yields. The procedure is well tolerated by patients, suited to the local anaesthetic outpatient setting and could directly replace transrectal ultrasound guided biopsy. Level of evidence: Level III

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