To investigate the clinical efficacy of a caudal block compared with periprostatic local anesthesia for transrectal ultrasound-guided multicore prostate needle biopsy.

A total of 100 patients who had undergone initial prostate biopsy using a systematic five-region biopsy by a single operator were investigated. The patients were randomly divided into two groups, with each group receiving a different anesthetic modality before biopsy. Group 1 received periprostatic local anesthesia and group 2 received a caudal block. Both groups received 10 mL 1% lidocaine before biopsy. A 10-point visual analog scale was used to assess patient pain and anxiety. The duration between anesthesia induction and the beginning of the biopsy was measured.

Patients who received local anesthesia (group 1) reported significantly less pain immediately after biopsy, with an average score of 1.1 compared with 2.1 in group 2 (caudal block, P = 0.01). Both groups were comparable regarding age, prostate-specific antigen level, digital rectal examination findings, prostate size, number of biopsy cores, level of prebiopsy anxiety, body mass index, and histologic findings. Group 1 required a significantly shorter period of anesthesia (198.5 seconds) than did group 2 (594.5 seconds, P <0.0001). No anesthetic-related side effects occurred in either group.

The results of our study have shown that the caudal block provides less effective anesthesia than periprostatic local anesthesia with the same dose of lidocaine for prostate biopsy. We have concluded that local anesthesia is a safe, simple, and rapid method of pain relief during prostate biopsy.