title: A randomised controlled trial comparing use of lignocaine periprostatic nerve block alone and combined with diclofenac suppository for patients undergoing transrectal ultrasound (TRUS)-guided prostate biopsy.
abstract: OBJECTIVE
  To examine whether or not the combination of diclofenac suppository with peri-prostatic nerve block (PPNB) was effective in reducing the degree of pain experienced during transrectal ultrasound (TRUS)-guided prostate biopsy in a randomised single-blind placebo-controlled trial.
  
  
  METHODS
  In all, 96 patients having a planned TRUS-guided prostate biopsy were randomised into one of the following arms on a 1:1 basis: 10 mL 1% lignocaine PPNB and placebo suppository (control) or 10 mL 1% lignocaine PPNB and 100 mg diclofenac suppository (treatment). Pain scores were recorded using the Numerical Rating Scale for pain (0-10) at the following time-points: (i) introduction of probe, (ii) during biopsy, (iii) 1 h after biopsy, (iv) later that evening (≈6 h after biopsy) and (v) 1 day after biopsy. Patients were asked about their preferred method for pain control if a repeat TRUS-guided prostate biopsy was required: local anaesthetic (LA) again or intravenous sedation.
  
  
  RESULTS
  There were no significant differences in age (P = 0.653) or PSA level (P = 0.584) between either study arm. The differences in pain scores between the control and treatment groups were not significant at Time 1 (probe insertion; P = 0.299), Time 2 (biopsy; P = 0.983), Time 4 (evening after; P = 0.231) and Time 5 (1 day after biopsy; P = 0.384). At Time 3 (1 h after biopsy), the control pain scale scores were statistically significantly higher than the treatment pain scale scores (P = 0.044). There was no difference between treatment (87%) and control (80%) groups as to whether they would prefer to repeat the biopsy under LA (P = 0.373).
  
  
  CONCLUSIONS
  The use of a diclofenac suppository with PPNB did not show any clinically meaningful effect in decreasing pain or improving tolerability of TRUS-guided prostate biopsy and is not recommended. PPNB TRUS-guided biopsy is extremely well tolerated, with >80% of patients electing for subsequent LA biopsy if required.
authors.affiliation: University of Western Australia, School of Surgery, Perth, Western Australia, Australia; Department of Urology, Fremantle Hospital, Perth, Western Australia, Australia.
authors.forename: Wei Ling
authors.initials: WL
authors.lastname: Ooi
authors.forename: Cynthia
authors.initials: C
authors.lastname: Hawks
authors.forename: Andrew H H
authors.initials: AH
authors.lastname: Tan
authors.forename: Dickon
authors.initials: D
authors.lastname: Hayne
mesh_terms: D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D001706:Biopsy / Q000379:methods; D004008:Diclofenac / Q000008:administration & dosage*; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D011467:Prostate / Q000473:pathology*; D016037:Single-Blind Method; D013488:Suppositories; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D013488:Suppositories; D004008:Diclofenac; D008012:Lidocaine
keywords: biopsy; diclofenac; lignocaine; prostate; transrectal