title: Comparative evaluation of periprostatic nerve block and diclofenac patch in transrectal ultrasound-guided prostatic needle biopsy.
abstract: BACKGROUND
  The aim of the present study was to compare two analgesic techniques for transrectal ultrasound (TRUS)-guided biopsy: diclofenac patch versus periprostatic nerve block with 1% lidocaine.
  
  
  OBJECTIVE
  To study the efficacy of and compare diclofenac patch and periprostatic nerve block as analgesia in TRUS-guided prostate needle biopsy.
  
  
  METHODS
  In total, 60 patients were prospectively randomized into three groups: those in whom a diclofenac patch was used (n = 20), those in whom periprostatic nerve block was used (n = 20), and a control group (n = 20). Prostate biopsy was performed after administration of analgesia according to group.
  
  
  RESULTS
  The three groups were similar in terms of age, prostate volume, and PSA (prostate-specific antigen) levels. Pain scores were significantly lower in the nerve block group (P = 0.000) at the time of biopsy until 2 h postprocedure, but not at 4 h postprocedure (P = 0.068). No significant difference in pain score was observed in the diclofenac patch group at the time of biopsy (P = 0.106) as compared to the control group, but the diclofenac patch provided adequate pain relief 1 h (P = 0.000), 2 h (0.000), and 4 h (0.002) postprocedure. No significant difference was observed in pain score between the nerve block (P = 0.520) and control groups (0.057) at probe insertion. The pain score at 4 h was significantly lower in the patch group compared to the nerve block and control groups.
  
  
  CONCLUSIONS
  Periprostatic nerve block provides superior analgesia for TRUS-guided biopsy. Diclofenac patch is useful as an adjunct.
authors.affiliation: Department of Surgery, Pandit B.D.Sharma University of Health Sciences, Rohtak, India.
authors.forename: Mahavir Singh
authors.initials: MS
authors.lastname: Griwan
authors.forename: Ashok
authors.initials: A
authors.lastname: Kumar
authors.forename: Jyotsna
authors.initials: J
authors.lastname: Sen
authors.forename: Santosh Kumar
authors.initials: SK
authors.lastname: Singh
keywords: Analgesia; Lidocaine; Pain