title: Control of pain during transrectal ultrasound-guided prostate biopsy: a prospective study comparing two methods.
abstract: OBJECTIVE
  To evaluate the efficacy of intramuscular injection of 75 mg diclofenac sodium and periprostatic nerve block (PPNB) with 1% lignocaine in controlling pain during transrectal ultrasound (TRUS)-guided prostate biopsy.
  
  
  METHODS
  A total of 120 patients undergoing TRUS-guided prostate biopsies were prospectively enrolled in the study. First, 20 patients did not get any form of analgesia/anesthesia and served as control; next, 20 patients received an intramuscular injection of diclofenac sodium. PPNB with 1% lignocaine was performed in the remaining 80 patients. Pain was assessed using Wong-Baker Faces Pain-Rating Scale (0-10).
  
  
  RESULTS
  All three groups of patients were comparable at baseline in terms of age, prostate-specific antigen and final histological diagnosis. The mean pain scores (+/-SD) for control, diclofenac and PPNB groups were 5.10 +/- 3.14, 3.70 +/- 2.36 and 2.24 +/- 1.63, respectively. The difference was statistically significant between control and PPNB (p = 0.001), and diclofenac and PPNB (p = 0.002), but not between the control and diclofenac group (p = 0.120). In addition, the proportion of patients having mild or no pain (defined as pain score <or=3) during the biopsy was greater in the PPNB group (71%) compared with the diclofenac group (45%) and the control group (30%) (p = 0.001). The total duration for TRUS biopsy was not significantly different between the three groups (p = 0.114).
  
  
  CONCLUSIONS
  PPNB with 1% lignocaine significantly decreases pain associated with prostate biopsy when compared with control and intramuscular diclofenac.
authors.affiliation: Department of Urology, National University Hospital, Singapore, Singapore.
authors.forename: K K
authors.initials: KK
authors.lastname: Bhomi
authors.forename: H H
authors.initials: HH
authors.lastname: Lim
authors.forename: D T
authors.initials: DT
authors.lastname: Consigliere
authors.forename: H Y
authors.initials: HY
authors.lastname: Tiong
mesh_terms: D000368:Aged; D001707:Biopsy, Needle; D016022:Case-Control Studies; D004008:Diclofenac / Q000008:administration & dosage*; D006801:Humans; D007273:Injections, Intramuscular; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement; D017060:Patient Satisfaction; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D018570:Risk Assessment; D016896:Treatment Outcome; D014463:Ultrasonography; D036761:Ultrasound, High-Intensity Focused, Transrectal / Q000009:adverse effects* / Q000379:methods
chemical_list: D004008:Diclofenac; D008012:Lidocaine