Premedication with Celecoxib Plus Tramadol and Intrarectal 2% Lidocaine vs Lidocaine Alone for Pain Control During Transrectal Ultrasound Guided Prostate Biopsy: A Randomized Controlled Trial

Abstract

Objective: Transrectal ultrasound guided biopsy is the diagnostic of choice in detecting carcinoma of the prostate. The biopsy can be painful and many would refuse the procedure again without adequate analgesia. The combination of non-steroidal anti-inflammatory drugs (NSAIDs) and opioids work synergistically in relieving pain. The investigators determined that the premedication of celecoxib and tramadol with 10ml intrarectal 2% lidocaine gel would significantly decrease the pain score of patients undergoing prostate biopsy compared to lidocaine gel alone. Methods: Thirty-one patients who underwent 12-core prostate biopsy were randomly assigned into two groups. The control received 10ml 2% intrarectal lidocaine gel alone and the experimental group was given celecoxib 400mg and tramadol 50 mg 2 hours before biopsy plus intrarectal lidocaine gel. Immediately after biopsy, patients were asked to rate the pain score using visual analog scale (VAS). Results: A total of 15 patients assigned for control group and 16 patients for the experimental group, showed similar characteristics in terms of age, prostate volume and prostate specific antigen (PSA) value. The overall mean pain score using visual analog pain scale was 4.1 +/- 1.7 in the experimental group compared to 5.5 +/- 1.9 in the control group with significant P value of 0.034 using chi-square test. There was a mean pain score decrease of 1.5 from the scale of 1 to 10 in the experimental group compared to the control. Conclusion: The addition of oral administration of celecoxib 400 mg and tramadol 50 mg 2 hours before intrarectal 10ml 2% lidocaine gel significantly reduced the pain experienced by patients during ultrasound guided prostate biopsy as compared to lidocaine gel alone. Key words: celecoxib, tramadol, lidocaine, transrectal ultrasound