Subcutaneous local anaesthetic after transperineal prostate biopsy under general anaesthesia: a randomised trial
- Author(s)
- Al-Khanaty, A; McGrath, S; Dinneen, E; Qin, K; Babst, C; Perera, M; Bolton, D; Lawrentschuk, N;
- Journal Title
- BJU International
- Publication Type
- Online publication before print
- Abstract
- OBJECTIVE: To determine whether subcutaneous local anaesthesia (LA) infiltration at perineal puncture sites reduces immediate postoperative pain after transperineal (TP) prostate biopsy performed under general anaesthesia (GA). METHODS: In this two-centre, patient-blinded, randomised, placebo-controlled trial, men undergoing TP prostate biopsy under GA (GATP biopsy) were allocated 1:1 to receive either 20 mL 0.5% bupivacaine or 20 mL normal saline, infiltrated subcutaneously into the perineal skin at the conclusion of biopsy. The primary endpoint was the proportion of patients reporting moderate-to-severe pain (visual analogue scale [VAS] score > 3) 30 min postoperatively. Secondary endpoints included the Short-Form McGill Pain Questionnaire (SF-MPQ) and opioid use in recovery. RESULTS: Of 150 men randomised, 140 were included in the modified intention-to-treat analysis. Moderate-to-severe pain occurred in 22.5% of controls and 8.7% of patients receiving LA (absolute risk reduction 13.8%, 95% confidence interval 2.1-25.6; P = 0.035; number needed to treat = 7). The median VAS and SF-MPQ scores were 0 in both groups. Opioid administration did not differ significantly (10% control vs 19% LA; P = 0.15). In an exploratory post hoc subgroup, the benefit of LA infiltration was greater among men undergoing >20-core biopsy (34.1% vs 10.6%). No significant complications occurred. CONCLUSION: Subcutaneous LA infiltration significantly reduces immediate moderate-to-severe pain following GATP biopsy. Although overall pain scores were low, a clinically meaningful subset benefitted from this simple, low-cost, and safe intervention. These findings also have relevance to contemporary TP prostate biopsy under LA workflows, supporting the concept that superficial infiltration may provide additive value alongside established block-based analgesic protocols.
- Keywords
- local anaesthetic; postoperative pain; prostate biopsy; randomised controlled trial; transperineal biopsy
- Department(s)
- Surgical Oncology
- Publisher's Version
- https://doi.org/10.1111/bju.70135
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- Refer to copyright notice on published article.
Creation Date: 2026-01-20 12:06:10
Last Modified: 2026-01-20 12:06:31