The use of anaesthetic for transrectal ultrasound- guided prostate biopsy

Background: Transrectal ultrasound-guided prostate biopsy is the gold standard technique for detecting prostate cancer, undertaken routinely without the use of local anaesthetic (LA) in our institution. Current national guidelines provided by The NHS Prostate Cancer Risk Management Programme and the National Institute for Health and Clinical Excellence recommend and support the use of local anaesthetic injection as the most effective form of pain relief. Methods: The primary aim of the study was to assess the impact of the introduction of national guidelines on the patient's pain perception of the procedure. Secondary aims were to compare the complication rates, i.e. bleeding, symptoms of infection and acceptance of a repeat procedure. A quantitative comparative study was performed. After the procedure, pain was evaluated using a questionnaire containing a visual analogue scale. A total of 75 consecutive patients' prospective, anonymized questionnaire data, from those who were given LA, were compared with data from 75 patients who underwent prostate biopsy before the introduction of local anaesthetic. Data were analysed using two independent samples tests. Results: The study findings supported the national clinical guidelines in the routine use of local anaesthetic during transrectal ultrasound-guided prostate biopsy: by demonstrating improvement in pain score, decreased reported discomfort and increased tolerability with no additional significant morbidity or complications. Conclusion: The study has informed future policy and protocols by providing evidence based practice. Current working practice has changed to the routine offer of LA and is at present considered the gold standard.