Local anesthesia for transperineal prostate biopsy performed under sedation: Effects on intraoperative and postoperative narcotic use Journal Article
| Authors: | Li, T.; McCready, T. M.; Nalavenkata, S.; Vertosick, E. A.; Eastham, J. A.; Ehdaie, B.; Coleman, J. A.; Touijer, K. A.; Gaffney, C.; Laudone, V. P.; Vickers, A. J.; Liso, N.; Fainberg, J. S. |
| Article Title: | Local anesthesia for transperineal prostate biopsy performed under sedation: Effects on intraoperative and postoperative narcotic use |
| Abstract: | Purpose: To investigate whether patients undergoing sedated prostate biopsies benefit from administration of local anesthetic. Materials and methods: 880 transperineal prostate biopsies were done under sedation at our institution between November 2022 and December 2023. We assessed the effect of bupivacaine on pain severity during post-anesthesia care unit (PACU) stay, use of narcotics in PACU, length of PACU stay, and urinary retention. Multivariable logistic regression was used for pain score and narcotics use outcomes; multivariable linear regression for PACU length of stay and intraoperative propofol use; and univariable logistic regression for urinary retention. Results: 340 patients received bupivacaine, 334 did not. Ten patients (3.0%) who received bupivacaine and 30 (9.0%) who did not had maximum PACU pain scores ≥ 5 (95% CI 3.5%-12%, p < 0.001). Nine (2.6%) in the bupivacaine group and 31 (9.3%) in the no-bupivacaine group received narcotics (95% CI 4.4%-13%, p < 0.001), indicating significantly higher risk of needing narcotics among patients not receiving bupivacaine. We found no evidence of an effect of bupivacaine use on PACU LOS (β -0.08 h, 95% CI -0.20-0.03, p = 0.15) or urinary retention (OR 0.78, 95% CI 0.19–2.99, p = 0.7). Bupivacaine was associated with less intraoperative fentanyl (IRR 0.67, 95% CI 0.50–0.89) but more propofol (adjusted difference 48 mg, 95% CI 25–71, p < 0.001). Conclusion: Local anesthetic at the time of sedated transperineal prostate biopsy reduces both intraoperative and postoperative narcotic use and causes less post-procedure pain. A randomized study to confirm this finding is warranted. © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2025. |
| Keywords: | pain; biopsy; prostate; diagnosis; anesthesia |
| Journal Title: | World Journal of Urology |
| Volume: | 43 |
| ISSN: | 0724-4983 |
| Publisher: | Springer |
| Date Published: | 2025-06-21 |
| Start Page: | 382 |
| Language: | English |
| DOI: | 10.1007/s00345-025-05746-7 |
| PROVIDER: | scopus |
| PUBMED: | 40542879 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF. Corresponding MSK author is Jonathan S. Fainberg -- Source: Scopus |
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