• Logo
  • SBMUJournals

Comparison of the Efficacy of Local Anesthesia Methods and Caudal Regional Anesthesia in Prostate Biopsy Applied Under Transrectal Ultrasonography: A Randomized Controlled Study

Sahin Pasali, Cuneyt Ozden, Yalcin Kizilkan, Suleyman Camgoz, Semih Baskan, Samet Senel, Doruk Demirel, Cevdet Serkan Gokkaya



Purpose: To evaluate the efficacy of caudal regional anesthesia and local anesthesia methods in prostate biopsy applied under transrectal ultrasonography.

Matherials and Methods: This prospective study included a total of 160 patients randomly separated into 4 equal groups as intrarectal local anesthesia (IRLA), periprostatic local anesthesia (PPLA), combined local anesthesia (IRLA+PPLA), and caudal regional anesthesia (CRA). The patients were evaluated using the pain scores on a visual analog scale.

Results: The pain score during anesthesia induction was significantly higher in the CRA group than in the IRLA and IRLA+PPLA groups (p<0.001). The pain score during entry of the probe to the rectum and movement was significantly lower in the CRA group than the IRLA groups (p=0.014). The pain score on penetration of the needle to the prostate and at 30 mins after the biopsy was significantly higher in the IRLA group (p<0.001). At 2 hours after the biopsy, the pain score in the CRA group was significantly lower than IRLA groups (p=0.015).

Conclusion: The PPLA alone can be applied more quickly than CRA, causes less pain during the application, and has similar efficacy in reducing pain during and after the prostate biopsy procedure.


pain, prostate biopsy, periprostatic local anaesthesia, caudal regional anaesthesia


Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359-86.

Mottet N, Bellmunt J, Bolla M, Briers E, Cumberbatch MG, De Santis M et al. EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol. 2017;71(4):618-629.

Packiam VT, Nottingham CU, Cohen AJ, Eggener SE, Gerber GS. No Effect of Music on Anxiety and Pain During Transrectal Prostate Biopsies: A Randomized Trial. Urology. 2018;117:31-35.

Litwin MS, Tan HJ. The Diagnosis and Treatment of Prostate Cancer: A Review. JAMA. 2017;317(24):2532-2542.

Zargar H, Marshall D, Siva G, King Q. Topical diltiazem before transrectal ultrasonography-guided biopsy of the prostate: a randomized controlled trial. ANZ J Surg. 2015;85(6):430-2.

Valdez-Flores RA, Campos-Salcedo JG, Torres-Gomez JJ, Sedano-Lozano A, Parés-Hipólito J, Shelton LM et al. Prospective comparison among three intrarectal anesthetic treatments combined with periprostatic nerve block during transrectal ultrasonography-guided prostate biopsy. World J Urol. 2018;36(2):193-199.

Gurbuz C, Canat L, Bayram G, Gokhan A, Samet G, Caskurlu T. Visual pain score during transrectal ultrasound-guided prostate biopsy using no anesthesia or three different types of local anaesthetic application. Scand J Urol Nephrol. 2010;44(4):212-6.

Otunctemur A, Dursun M, Besiroglu H, Can Polat E, Cakir SS, Ozbek et al. The effectivity of periprostatic nerve blockade for the pain control during transrectal ultrasound guided prostate biopsy. Arch Ital Urol Androl. 2013;85(2):69-72.

Wang N, Fu Y, Ma H, Wang J, Gao Y. Advantages of caudal block over intrarectal local anesthesia plus periprostatic nerve block for transrectal ultrasound guided prostate biopsy. Pak J Med Sci. 2016;32(4):978-82.

Cesur M, Yapanoglu T, Erdem AF, Ozbey I, Alici HA, Aksoy Y. Caudal analgesiafor prostate biopsy. Acta Anaesthesiol Scand. 2010;54(5):557-61.

Li M, Wang Z, Li H, Yang J, Rao K, Wang T, Wang S, Liu J. Local anesthesia for transrectal ultrasound-guided biopsy of the prostate: A meta-analysis. Sci Rep. 2017;7:40421.

Nazir B. Pain during transrectal ultrasound-guided prostate biopsy and the role of periprostatic nerve block: what radiologists should know. Korean J Radiol. 2014;15(5):543-53.

Yan P, Wang XY, Huang W, Zhang Y. Local anesthesia for pain control during transrectal ultrasound-guided prostate biopsy: a systematic review and meta-analysis. J Pain Res. 2016 11;9:787-796.

Yang Y, Liu Z, Wei Q, Cao D, Yang L, Zhu Y et al. The Efficiency and Safety of Intrarectal Topical Anesthesia for Transrectal Ultrasound-Guided Prostate Biopsy: A Systematic Review and Meta-Analysis. Urol Int. 2017;99(4):373-383.

Horinaga M, Nakashima J, Nakanoma T. Efficacy compared between caudal block and periprostatic local anesthesia for transrectal ultrasound-guided prostate needle biopsy. Urology. 2006;68(2):348-51.

Ikuerowo SO, Popoola AA, Olapade-Olaopa EO, Okeke LI, Shittu OB, Adebayo SA et al. Caudal block anesthesia for transrectal prostate biopsy. Int Urol Nephrol. 2010;42(1):19-22.

Urabe F, Kimura T, Shimomura T, Onuma H, Yamamoto T, Sasaki H, et al. Prospective comparison of the efficacy of caudal versus periprostatic nerve block, both with intrarectal local anesthesia, during transrectal ultrasonography-guided prostatic needle biopsy. Scand J Urol. 2017;51(4):245-250.

DOI: http://dx.doi.org/10.22037/uj.v0i0.5503


  • There are currently no refbacks.