Local anesthesia for transperineal prostate biopsy performed under sedation: effects on intraoperative and postoperative narcotic use.

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.