Efficacy of periprostatic local anesthetic for prostate biopsy analgesia: A meta-analysis

Richman, Jeffrey M.; Carter, H. Ballentine; Hanna, Marie N.; Murphy, Jamie D.; Rowlingson, Andrew J.; Andrews, Robert A.F.; Wu, Christopher L.

doi:10.1016/j.urology.2005.12.030

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Volume 67, Issue 6 , Pages 1224-1228, June 2006

Efficacy of periprostatic local anesthetic for prostate biopsy analgesia: A meta-analysis

Jeffrey M. Richman
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, Maryland, USA
H. Ballentine Carter
- Department of Urology, The Johns Hopkins University, Baltimore, Maryland, USA
Marie N. Hanna
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, Maryland, USA
Jamie D. Murphy
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, Maryland, USA
Andrew J. Rowlingson
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, Maryland, USA
Robert A.F. Andrews
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, Maryland, USA
Christopher L. Wu
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, Maryland, USA
- Reprint requests: Christopher L. Wu, M.D., The Johns Hopkins Hospital, Department of Anesthesiology and Critical Care Medicine, Carnegie 280, 600 North Wolfe Street, Baltimore, MD 21287.

Received 20 September 2005; accepted 14 December 2005.

Abstract

Objectives

To perform a meta-analysis of available randomized trials investigating the analgesic efficacy of periprostatic block with local anesthetic.

Methods

The National Library of Medicine’s PubMed database was searched for the time period 1966 to August 16, 2005 for all relevant articles. Inclusion criteria included subjects undergoing prostate biopsy, trials that were randomized with one arm of the randomization using local anesthetic for periprostatic block before prostate biopsy, and where the assessment of biopsy pain was measured and available in a form compatible for statistical analysis in our meta-analysis.

Results

Our search resulted in 107 abstracts, of which a total of 16 articles met all inclusion criteria. There were 660 subjects who received local anesthetics for a periprostatic block and 616 subjects who did not. The weighted mean difference between the groups indicates that subjects receiving local anesthetic periprostatic block would have a statistically lower pain score compared with those who did not (weighted mean difference in visual analogue pain of −1.66 [95% confidence interval −2.03 to −1.29]).

Conclusions

Our meta-analysis suggests that periprostatic block with local anesthetic for prostate biopsy might result in significantly lower levels of pain during the biopsy procedure. Because periprostatic block with local anesthetic is relatively easy to administer and does not seem to be associated with increased morbidity, clinicians performing prostate biopsies should consider using this technique on a routine basis.