- Objectives To modify our technique of perianal anesthesia and use it in patients with painful conditions of the rectum and/or anus. Methods A total of 31 consecutive patients with anal-rectal problems underwent prostate needle biopsy. Of these, 17 were referred to our hospital after vain attempts to insert a transrectal ultrasound probe. Patients received a perianal-pericapsular injection of 1% lidocaine. Pain perception was separately assessed for probe insertion and biopsies using a visual pain analog score. Results Only in 1 patient were we unable to insert the transrectal ultrasound probe. The mean patient age was 65.28 ± 5.35 years. We performed a mean of 12.25 biopsies per case. At probe insertion, the mean pain score was 2.2 ± 0.83. During the biopsy punctures, the mean pain level was 2.53 ± 1.054. We did not find any increase in the complication rate related to the anesthesia method. Conclusions Modified perianal anesthesia can be used for transrectal ultrasound-guided biopsy of the prostate in patients with anal-rectal problems, because it provides significant pain relief.