Local anesthesia in transrectal ultrasound-guided prostate biopsy: EMLA cream as a new alternative technique

Abstract

Objectives. The aims of the present study were to evaluate the efficacy of eutectic mixture of local anesthetics ( EMLA) cream in transrectal-guided prostate biopsy and to compare its effect with that of other injectable anesthetic procedures. Material and methods. Eighty male patients with prostate-specific antigen (PSA) levels >4 ng/ml or who had prostate nodules on digital rectal examination were randomly divided into four groups. In Group 1 ( controls), prostate biopsy was performed after application of a placebo cream. In Group 2, local surface anesthesia with EMLA cream was performed 15 min before biopsy. Periprosthetic nerve blockade was performed with 1% prilocaine and 1% lidocaine in Groups 3 and 4, respectively. Pain was evaluated using a visual analog scale (VAS) after each core biopsy. In addition, blood pressure, heart rate and oxygen saturations were recorded after each biopsy and then at 5-min intervals for 15 min. Results. Average VAS scores in Groups 1-4 were 5.5, 2.9, 2.4 and 2.2, respectively. There was a statistically significant difference in VAS scores between the treatment groups and the placebo group (p=0.000). There were no statistically significant differences in VAS scores between the three treatment groups (p(2-3) = 0.126, p(2-4) = 0.303, p(3-4) = 0.537). We detected no statistically significant differences between the groups based on the hemodynamic data (p(MAP) = 0.899). Moreover, these measurements did not show statistically significant changes with time in any of the groups (p > 0. 05). Conclusion. Intrarectal application of EMLA cream provides equal anesthesia to periprostatic nerve blockade with prilocaine and lidocaine.