Anorectal Application of 5% Lidocaine Cream Reduces Pain Prior to Periprostatic Nerve Block During Transrectal Ultrasound Guided Biopsy

NCT ID: NCT04064047

Last Updated: 2020-01-13

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

284 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-12-31

Study Completion Date

2017-07-31

Brief Summary

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Transrectal ultrasound guided prostate biopsy is performed with a periprostatic nerve block to the neurovascular bundle bilaterally. This does not reduce the pain due to probe insertion and manipulation prior to nerve blockage.

Our study goal is to assess whether topical analgesia would reduce pain during the early stages of the procedure.

Detailed Description

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Prospective, randomized controlled study. Patients signed an informed consent form. Exclusion criteria were Lidocaine allergy or pre-planned general anesthesia.

Patients were randomized into 6 groups: (1) nerve block with 5 ml 1% lidocaine for each neurovascular bundle + perianal topical application of 10 ml 5% lidocaine cream; (2) as in (1) plus application of 10 ml 5% lidocaine cream evenly on rectal walls. For each approach exposure times of 5, 10 and 20 minutes were allowed, all together 6 groups plus a control group of patients who received periprostatic nerve block only. A 0-10 Visual analogue scale (VAS) was filled by the patients at 5 time points: immediately after probe insertion, during probe manipulation and prostate assessment, immediately following neurovascular bundle nerve blockage, after prostate biopsies and a global pain estimation of the procedure.

Conditions

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Pain Prostate Cancer Rectal/Anal

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

SINGLE

Participants

Study Groups

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External Anal application - 5 minutes exposure

Anal application of lidocaine cream 5% for 5 minutes before probe insertion. After probe insertion and prior to biopsy, a periprostatic nerve block was performed with 10 mL of 1% Lidocaine (5 mL on each side).

Group Type ACTIVE_COMPARATOR

Trans rectal ultrasound guided prostate biopsy

Intervention Type PROCEDURE

The investigators checked visual analogue scale of pain at different time periods: prior to probe insertion, during probe insertion. during probe manipulation in the rectum, during performance of periprostatic nerve block, during actual biopsy collection and at termination of procedure.

Trans rectal ultrasound

Intervention Type PROCEDURE

Performing a prostate biopsy using a transrectal ultrasound probe - the BK pro focus 2202 transrectal ultrasound and the 8808 bi-plane transrectal probe

Prostate biopsy

Intervention Type PROCEDURE

Prostate biopsy guided by a transrectal ultrasound with an 18 gauge needle

Periprostatic nerve block

Intervention Type PROCEDURE

Performing a bilateral peri-prostatic nerve block with 10 mL of 1% lidocaine (5 mL on each side)

External Anal application - 10 minutes exposure

Anal application of lidocaine cream 5% for 10 minutes before probe insertion. After probe insertion and prior to biopsy, a periprostatic nerve block was performed with 10 mL of 1% Lidocaine (5 mL on each side).

Group Type ACTIVE_COMPARATOR

Trans rectal ultrasound guided prostate biopsy

Intervention Type PROCEDURE

The investigators checked visual analogue scale of pain at different time periods: prior to probe insertion, during probe insertion. during probe manipulation in the rectum, during performance of periprostatic nerve block, during actual biopsy collection and at termination of procedure.

Trans rectal ultrasound

Intervention Type PROCEDURE

Performing a prostate biopsy using a transrectal ultrasound probe - the BK pro focus 2202 transrectal ultrasound and the 8808 bi-plane transrectal probe

Prostate biopsy

Intervention Type PROCEDURE

Prostate biopsy guided by a transrectal ultrasound with an 18 gauge needle

Periprostatic nerve block

Intervention Type PROCEDURE

Performing a bilateral peri-prostatic nerve block with 10 mL of 1% lidocaine (5 mL on each side)

External Anal application - 20 minutes exposure

Anal application of lidocaine cream 5% for 20 minutes before probe insertion. After probe insertion and prior to biopsy, a periprostatic nerve block was performed with 10 mL of 1% Lidocaine (5 mL on each side).

Group Type ACTIVE_COMPARATOR

Trans rectal ultrasound guided prostate biopsy

Intervention Type PROCEDURE

The investigators checked visual analogue scale of pain at different time periods: prior to probe insertion, during probe insertion. during probe manipulation in the rectum, during performance of periprostatic nerve block, during actual biopsy collection and at termination of procedure.

Trans rectal ultrasound

Intervention Type PROCEDURE

Performing a prostate biopsy using a transrectal ultrasound probe - the BK pro focus 2202 transrectal ultrasound and the 8808 bi-plane transrectal probe

Prostate biopsy

Intervention Type PROCEDURE

Prostate biopsy guided by a transrectal ultrasound with an 18 gauge needle

Periprostatic nerve block

Intervention Type PROCEDURE

Performing a bilateral peri-prostatic nerve block with 10 mL of 1% lidocaine (5 mL on each side)

External Anal plus intrarectal - 5 minutes exposure

Anal application plus intrarectal application of 5% lidocaine cream for 5 minutes before probe insertion.

After probe insertion and prior to biopsy, a periprostatic nerve block was performed with 10 mL of 1% Lidocaine (5 mL on each side).

Group Type ACTIVE_COMPARATOR

Trans rectal ultrasound guided prostate biopsy

Intervention Type PROCEDURE

The investigators checked visual analogue scale of pain at different time periods: prior to probe insertion, during probe insertion. during probe manipulation in the rectum, during performance of periprostatic nerve block, during actual biopsy collection and at termination of procedure.

Trans rectal ultrasound

Intervention Type PROCEDURE

Performing a prostate biopsy using a transrectal ultrasound probe - the BK pro focus 2202 transrectal ultrasound and the 8808 bi-plane transrectal probe

Prostate biopsy

Intervention Type PROCEDURE

Prostate biopsy guided by a transrectal ultrasound with an 18 gauge needle

Periprostatic nerve block

Intervention Type PROCEDURE

Performing a bilateral peri-prostatic nerve block with 10 mL of 1% lidocaine (5 mL on each side)

External Anal plus intrarectal - 10 minutes exposure

Anal application plus intrarectal application of 5% lidocaine cream for 10 minutes before probe insertion.

After probe insertion and prior to biopsy, a periprostatic nerve block was performed with 10 mL of 1% Lidocaine (5 mL on each side).

Group Type ACTIVE_COMPARATOR

Trans rectal ultrasound guided prostate biopsy

Intervention Type PROCEDURE

The investigators checked visual analogue scale of pain at different time periods: prior to probe insertion, during probe insertion. during probe manipulation in the rectum, during performance of periprostatic nerve block, during actual biopsy collection and at termination of procedure.

Trans rectal ultrasound

Intervention Type PROCEDURE

Performing a prostate biopsy using a transrectal ultrasound probe - the BK pro focus 2202 transrectal ultrasound and the 8808 bi-plane transrectal probe

Prostate biopsy

Intervention Type PROCEDURE

Prostate biopsy guided by a transrectal ultrasound with an 18 gauge needle

Periprostatic nerve block

Intervention Type PROCEDURE

Performing a bilateral peri-prostatic nerve block with 10 mL of 1% lidocaine (5 mL on each side)

External Anal plus intrarectal - 20 minutes exposure

Anal application plus intrarectal application of 5% lidocaine cream for 20 minutes before probe insertion.

After probe insertion and prior to biopsy, a periprostatic nerve block was performed with 10 mL of 1% Lidocaine (5 mL on each side).

Group Type ACTIVE_COMPARATOR

Trans rectal ultrasound guided prostate biopsy

Intervention Type PROCEDURE

The investigators checked visual analogue scale of pain at different time periods: prior to probe insertion, during probe insertion. during probe manipulation in the rectum, during performance of periprostatic nerve block, during actual biopsy collection and at termination of procedure.

Trans rectal ultrasound

Intervention Type PROCEDURE

Performing a prostate biopsy using a transrectal ultrasound probe - the BK pro focus 2202 transrectal ultrasound and the 8808 bi-plane transrectal probe

Prostate biopsy

Intervention Type PROCEDURE

Prostate biopsy guided by a transrectal ultrasound with an 18 gauge needle

Periprostatic nerve block

Intervention Type PROCEDURE

Performing a bilateral peri-prostatic nerve block with 10 mL of 1% lidocaine (5 mL on each side)

Control group

No anal application of lidocaine cream prior to probe insertion. After probe insertion and prior to biopsy, a periprostatic nerve block was performed with 10 mL of 1% Lidocaine (5 mL on each side).

Group Type SHAM_COMPARATOR

Trans rectal ultrasound guided prostate biopsy

Intervention Type PROCEDURE

The investigators checked visual analogue scale of pain at different time periods: prior to probe insertion, during probe insertion. during probe manipulation in the rectum, during performance of periprostatic nerve block, during actual biopsy collection and at termination of procedure.

Trans rectal ultrasound

Intervention Type PROCEDURE

Performing a prostate biopsy using a transrectal ultrasound probe - the BK pro focus 2202 transrectal ultrasound and the 8808 bi-plane transrectal probe

Prostate biopsy

Intervention Type PROCEDURE

Prostate biopsy guided by a transrectal ultrasound with an 18 gauge needle

Periprostatic nerve block

Intervention Type PROCEDURE

Performing a bilateral peri-prostatic nerve block with 10 mL of 1% lidocaine (5 mL on each side)

Interventions

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Trans rectal ultrasound guided prostate biopsy

The investigators checked visual analogue scale of pain at different time periods: prior to probe insertion, during probe insertion. during probe manipulation in the rectum, during performance of periprostatic nerve block, during actual biopsy collection and at termination of procedure.

Intervention Type PROCEDURE

Trans rectal ultrasound

Performing a prostate biopsy using a transrectal ultrasound probe - the BK pro focus 2202 transrectal ultrasound and the 8808 bi-plane transrectal probe

Intervention Type PROCEDURE

Prostate biopsy

Prostate biopsy guided by a transrectal ultrasound with an 18 gauge needle

Intervention Type PROCEDURE

Periprostatic nerve block

Performing a bilateral peri-prostatic nerve block with 10 mL of 1% lidocaine (5 mL on each side)

Intervention Type PROCEDURE

Other Intervention Names

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BK pro focus 2202 transrectal ultrasound and the 8808 bi-plane transrectal probe

Eligibility Criteria

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Inclusion Criteria

* Males referred to TRUSGBx due to elevated prostate specific antigen (PSA)
* Abnormal findings on digital rectal examination (DRE)
* Repeat biopsies as part of Active Surveillance (AS)
* Continuously elevated PSA levels despite prior negative for malignancy biopsies
* Previous histological findings of significant HGPIN were enrolled

Exclusion Criteria

* Known sensitivity to Lidocaine
* Pre-planned biopsy under general anesthesia
Minimum Eligible Age

18 Years

Eligible Sex

MALE

Accepts Healthy Volunteers

No

Sponsors

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Assaf-Harofeh Medical Center

OTHER_GOV

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Judith Ben Zvi

Role: STUDY_CHAIR

Assaf Harofeh Medical Center ethical committee for experiments in humans

References

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Lee C, Woo HH. Current methods of analgesia for transrectal ultrasonography (TRUS)-guided prostate biopsy -- a systematic review. BJU Int. 2014 Mar;113 Suppl 2:48-56. doi: 10.1111/bju.12433.

Reference Type RESULT
PMID: 24053451 (View on PubMed)

Tiong HY, Liew LC, Samuel M, Consigliere D, Esuvaranathan K. A meta-analysis of local anesthesia for transrectal ultrasound-guided biopsy of the prostate. Prostate Cancer Prostatic Dis. 2007;10(2):127-36. doi: 10.1038/sj.pcan.4500935. Epub 2007 Jan 9.

Reference Type RESULT
PMID: 17211441 (View on PubMed)

Wang J, Wang L, Du Y, He D, Chen X, Li L, Nan X, Fan J. Addition of intrarectal local analgesia to periprostatic nerve block improves pain control for transrectal ultrasonography-guided prostate biopsy: a systematic review and meta-analysis. Int J Urol. 2015 Jan;22(1):62-8. doi: 10.1111/iju.12595. Epub 2014 Aug 21.

Reference Type RESULT
PMID: 25141759 (View on PubMed)

Raber M, Scattoni V, Roscigno M, Deho F, Briganti A, Salonia A, Gallina A, Di Girolamo V, Montorsi F, Rigatti P. Topical prilocaine-lidocaine cream combined with peripheral nerve block improves pain control in prostatic biopsy: results from a prospective randomized trial. Eur Urol. 2008 May;53(5):967-73. doi: 10.1016/j.eururo.2007.09.005. Epub 2007 Sep 18.

Reference Type RESULT
PMID: 17904278 (View on PubMed)

Giannarini G, Autorino R, Valent F, Mogorovich A, Manassero F, De Maria M, Morelli G, Barbone F, Di Lorenzo G, Selli C. Combination of perianal-intrarectal lidocaine-prilocaine cream and periprostatic nerve block for pain control during transrectal ultrasound guided prostate biopsy: a randomized, controlled trial. J Urol. 2009 Feb;181(2):585-91; discussion 591-3. doi: 10.1016/j.juro.2008.10.002. Epub 2008 Dec 13.

Reference Type RESULT
PMID: 19084860 (View on PubMed)

Barcohana N, Duperon DF, Yashar M. The relationship of application time to EMLA efficacy. J Dent Child (Chic). 2003 Jan-Apr;70(1):51-4.

Reference Type RESULT
PMID: 12762609 (View on PubMed)

Other Identifiers

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Assaf-HarofehMC 0289-15-ASF

Identifier Type: -

Identifier Source: org_study_id

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