title: A randomized, controlled trial comparing lidocaine periprostatic nerve block, diclofenac suppository and both for transrectal ultrasound guided biopsy of prostate.
abstract: OBJECTIVE
  Lidocaine periprostatic nerve block (PPNB) provides good procedural pain relief for transrectal ultrasound (TRUS) prostatic biopsy. However, post-procedural pain can be significant. The addition of diclofenac suppository (DS) to lidocaine PPNB might provide additional, particularly post-procedural pain relief. We assessed the procedural and post-procedural pain relief for TRUS biopsy provided by DS, and the combination of DS and lidocaine PPNB compared with lidocaine PPNB alone.
  
  
  METHODS
  A total of 165 patients were randomized into 3 groups, namely group 1-lidocaine PPNB, group 2-DS and group 3-a combination of lidocaine PPNB and DS. In all patients 12 core biopsy was performed. Pain/discomfort at various intervals after the procedure was recorded on a visual analogue scale of 0 to 10 cm.
  
  
  RESULTS
  Biopsy pain was significantly lower in patients who received lidocaine alone or in combination compared with DS alone (median 1.95, IQR 1.08 to 3.12, 3, IQR 1.25 to 5.47 and 1.8, IQR 0.85 to 3.0, respectively, p = 0.018), while evening pain scores were significantly lower in patients who received DS alone or in combination compared with that in patients who received lidocaine alone (median 1.25, IQR 0.38 to 3.0, 0.3, IQR 0.03 to 1.08 and 0.4, IQR 0 to 1.0, respectively, p = 0.001). There were no significant differences in pain/discomfort due to the probe (p = 0.107), that 1 hour after biopsy (p = 0.076) and that on the day after the procedure (p = 0.165). There were no significant differences in hemorrhagic or infective complications among the groups.
  
  
  CONCLUSIONS
  The combination of lidocaine PPNB with DS provides additional pain relief during and after prostatic TRUS biopsy.
authors: Michael Heal Department of Urology, Leighton Hospital, Crewe and University of Sheffield, Sheffield, United Kingdom. n_ragavan@yahoo.com
authors: N
authors: N
authors: Ragavan
authors: J
authors: J
authors: Philip
authors: S P
authors: SP
authors: Balasubramanian
authors: J
authors: J
authors: Desouza
authors: C
authors: C
authors: Marr
authors: P
authors: P
authors: Javle
mesh_terms: D000368:Aged; D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D004008:Diclofenac / Q000008:administration & dosage*; D006801:Humans; D008012:Lidocaine; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D011467:Prostate / Q000473:pathology*; D013488:Suppositories; D036761:Ultrasound, High-Intensity Focused, Transrectal
chemical_list: D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D013488:Suppositories; D004008:Diclofenac; D008012:Lidocaine