title: Comparison of the efficacy and safety of topical diltiazem and nitroglycerine for pain relief during transrectal ultrasound guided biopsy of the prostate.
abstract: OBJECTIVE
  Transrectal ultrasound biopsy of prostate is a painful procedure. The introduction of the rectal probe is one of the major contributors to the pain associated with this procedure. Drugs that relax the anal sphincter should theoretically decrease this pain. This study was done to compare the efficacy and safety of two topical medications that relax the anal sphincter, diltiazem and nitroglycerine, in decreasing the pain associated with transrectal ultrasound guided prostate biopsy.
  
  
  METHODS
  66 patients who were to undergo their first prostate biopsy were randomized to receive either 2 mL of 2 % topical diltiazem or 2 mL of 0.2 % topical nitroglycerine or placebo 20 minutes before prostate biopsy. All patients also received 15 mL of intrarectal lignocaine. A 10-point visual analogue score was used to record the pain immediately after the insertion of the probe, during biopsy and at the end of the procedure.
  
  
  RESULTS
  The pain scores due to probe insertion, during biopsy and at the end of the procedure in patients who received topical diltiazem or nitroglycerine were significantly lower compared to the placebo group (p < 0.001). There were no significant differences in the pain scores between the patients receiving diltiazem compared to those receiving nitroglycerine. Higher incidence of headache and fall in blood pressure was noted in patients who received nitroglycerine compared to those receiving diltiazem.
  
  
  CONCLUSIONS
  Topical diltiazem and nitroglycerine are equally effective in reducing the pain associated with transrectal prostatic biopsy. Diltiazem is safer compared to nitroglycerine.
authors: Department of Urology, Calcutta National Medical College, Kolkata, India. drtarunjindal@gmail.com
authors: Tarun
authors: T
authors: Jindal
authors: Soumendra Nath
authors: SN
authors: Mandal
authors: Satyadip
authors: S
authors: Mukherjee
authors: Dilip
authors: D
authors: Karmakar
mesh_terms: D000284:Administration, Oral; D000285:Administration, Rectal; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage*; D004110:Diltiazem / Q000008:administration & dosage*; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007431:Intraoperative Complications / Q000188:drug therapy*; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000008:administration & dosage*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine; D004110:Diltiazem; D005996:Nitroglycerin