Ismail, M.A., Kamal, A.M., Ghobashy, S., Al Baz, A.G., & Roshdy, M. (2015). Comparison of pain control during Trus guided biopsies between basal peri-prostatic local infiltration anesthesia versus combined topical anal lignocaine ointment and local infiltration anesthesia. Journal of the Egyptian Society of Parasitology, 45, 285–289.

To compare two techniques for pain relief with ​transrectal ultrasonography (TRUS)-guided biopsies

Patients undergoing prostate biopsies were randomized to receive either local infiltration anesthesia alone or a combination of local anesthesia and lignocaine 5% ointment to the anal rind, canal, and anterior rectal wall. Patients were asked to rate pain during insertion, during infiltration, and after biopsy.

• N = 163
• MEAN AGE = 61.7 years (range = 50–88 years)
• MALES: 100%         
• KEY DISEASE CHARACTERISTICS: All had elevated prostate-specific antigens

• SITE: Single site  
• SETTING TYPE: Not specified  
• LOCATION: Egypt

• PHASE OF CARE: Diagnostic

Randomized trial

• 100 mm Visual Analog Scale (VAS) for pain

Patients who received a combination of local and topical anesthesia reported significantly less pain (p = 0.005) at all stages of the procedure.

The combination of a local anesthetic infusion with a topical anesthetic may provide better pain control during biopsy.

• Risk of bias (no blinding)
• Measurement/methods not well described
• Measurement validity/reliability questionable
• Other limitations/explanation: Data regarding pain differences were reported using different numeric scales, so the actual method of measurement and resulting analysis was unclear. It was unclear how patients during biopsy could reasonably use the VAS to report pain.

The combination of anesthetic infiltration and a local topical anesthetic may reduce pain during biopsy.