scholarly journals Lidocaine spray administration in transrectal ultrasound-guided prostate biopsy: Five years of experience

2014 ◽  
Vol 86 (4) ◽  
pp. 340 ◽  
Author(s):  
Lucio Dell’Atti
Keyword(s):  
Pain Score ◽  
Prostate Biopsy ◽  
Low Cost ◽  
Prostate Gland ◽  
Transrectal Ultrasound ◽  
Pain Scale ◽  
Patient Comfort ◽  
Ultrasound Guided ◽  
Male Patients ◽  
Lidocaine Spray

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.

scholarly journals Effective Concentration of Lidocaine Plus Fentanyl for Caudal Block in Patients Undergoing Transrectal Ultrasound Guided Prostate Biopsy

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Jinguo Wang ◽  
Honglan Zhou ◽  
Wei An ◽  
Na Wang ◽  
Yang Gao
Keyword(s):  
Side Effects ◽  
Prostate Biopsy ◽  
Pain Perception ◽  
Transrectal Ultrasound ◽  
Effective Concentration ◽  
Mixed Solution ◽  
Caudal Block ◽  
Ultrasound Guided ◽  
Step Size ◽  
Male Patients

Objective. This study determined the effective concentration (EC) of lidocaine plus 75 μg fentanyl for caudal block in patients undergoing transrectal ultrasound (TRUS) guided prostate biopsy. Methods. Consecutive male patients scheduled for TRUS guided prostate biopsy were enrolled. The mixed solution for caudal block contained lidocaine and 75 μg fentanyl, in total 20 mL. The concentration of lidocaine was determined using the up-and-down method, starting at 0.8% (a step size of 0.1%). A successful caudal block was defined by no pain perception during biopsy. The EC50 of lidocaine for successful caudal block was calculated and side effects were evaluated. Results. A total of 23 patients were recruited. The EC50 of lidocaine for successful caudal block was 0.53%. Conclusions. Lidocaine of 0.53% combined with 75 μg fentanyl resulted in excellent caudal block in 50% of male patients undergoing transrectal ultrasound guided prostate biopsy.

scholarly journals Safety of transrectal ultrasound-guided prostate biopsy in patients affected by Crohn’s disease

2017 ◽  
Vol 89 (2) ◽  
pp. 106
Author(s):  
Lucio Dell'Atti ◽  
Andrea Benedetto Galosi
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Prostate Biopsy ◽  
Transrectal Ultrasound ◽  
Pain Scale ◽  
Ultrasound Guided ◽  
Chronic Inflammatory Condition ◽  
Small Cohort ◽  
Unbearable Pain ◽  
Remission Phase

Purpose: Crohn’s disease (CD) is a chronic inflammatory condition of the gastrointestinal tract. It is usually considered a contraindication to transrectal ultrasound-guided prostate biopsy (TRUSBx). The aim of this study was to investigate the safety of TRUSBx in a small cohort of patients with CD. Methods: We queried our institutional database clinical data of patients with a diagnosis of CD undergoing TRUSBx, and a retrospective prospective study of 5 patients was planned. All patients enrolled were in the remission phase of CD and asymptomatic. They received the same antibiotic prophylaxis and a povidone-iodine aqueous solution enema before the procedure. A standardized reproducible technique was used with using a ultrasound machine equipped with a 5-9 MHz multifrequency convex probe “end-fire”. The patients were treated under local anaesthesia, and a 14-core biopsy scheme was performed in each patient as first intention. After the procedure each patient was given a verbal numeric pain scale to evaluate tolerability of TRUSBx. Results: TRUSBx was successfully completed in all patients. The number of biopsy cores was 14 (12-16). Of the 5 biopsy procedures performed 40% revealed prostatic carcinoma (PCa) with a Gleason score 6 (3+3). No patients required catheterization or admission to the hospital for adverse events after the procedure. The most frequent adverse event was hematospermia (60%), while hematuria was present in 20% of patients and a minimal rectal bleeding in 20% of the patients. No patients reported severe or unbearable pain (score ≥ 8). Conclusions: This study suggests that CD may not be an absolute contraindication to TRUSBx for prostate cancer detection, but still requires a careful patients selection.

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