Sedation with midazolam versus local anaesthesia with lignocaine for transrectal prostate biopsies

Transrectal ultrasound-guided needle biopsy of the prostate is the only method for diagnosing prostate cancer. Although tolerated by most patients, 65-90% of patients complain of pain during the procedure. Most urologists utilize ultrasound-guided transrectal injection of lignocaine. Intravenous sedation with short-acting medications such as midazolam has been successfully used during many invasive ambulatory procedures, reducing discomfort and anxiety. The aim of this study was to compare the efficacy of pain and anxiety reduction using intravenous sedation with midazolam versus local anaesthesia with lignocaine during transrectal biopsies of the prostate in a cross-sectional study. Ninety consecutive candidates for transrectal prostate biopsy were divided into 2 groups. Group A received periprostatic block with 2% lignocaine and group B received sedation with intravenous injection of 4 mg midazolam prior to insertion of the probe. Side-effects and patient satisfaction were documented by questionnaires, which included a pain visual analogue scale (VAS). Significant differences were found between the two groups with respect to the patient's perceived intensity of pain. Pain level expressed by a VAS was 4·2 in group A and 1·9 in group B (P<0·001). Eighty-seven per cent of the patients in group B stated that they would be willing to repeat the procedure if necessary compared with 55% in group A (P=0·002). There were no complications or side-effects as a result of midazolam sedation. Midazolam is more effective in relieving pain and anxiety during transrectal prostate biopsies and as safe as a local injection of lignocaine.