Local Anesthetic Reduces Pain Associated with Transrectal Ultrasound-Guided Prostate Biopsy: A Meta-analysis

ObjectivesTo determine whether local anesthetic decreases the pain associated with transrectal ultrasound-guided prostate needle biopsy.MethodsA systematic review and meta-analysis was performed of randomized clinical trials of periprostatic local anesthetic for prostate biopsy. The primary outcome was pain as determined by the visual analog scale. The standardized mean differences between groups were estimated using the DerSimonian and Laird random effects models.ResultsFourteen trials with a total of 994 patients met the inclusion criteria for this study. Pooled data analysis demonstrated significantly decreased pain with the use of local anesthetic. The standardized mean difference in the pain score comparing local anesthetic to placebo or nothing was −1.05 (95% confidence interval −1.40 to −0.71, P <0.001). Begg’s test (P = 0.34) and Egger’s test (P = 0.50) showed no evidence of significant publication bias. Sensitivity analysis showed only slight changes in the effect estimate with sequential omission of each trial or with repetition of the analysis with subgroups of trials based on likely sources of heterogeneity.ConclusionsThe results of our analysis have shown that compared with no anesthetic, periprostatic local anesthetic significantly decreases the pain associated with transrectal ultrasound-guided prostate needle biopsy.