Control of Pain during Transrectal Ultrasound-Guided Prostate Biopsy: A Prospective Study Comparing Two Methods

Abstract

Aim: 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. Materials and 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 ≤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). Conclusion: PPNB with 1% lignocaine significantly decreases pain associated with prostate biopsy when compared with control and intramuscular diclofenac.