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Year : 2005  |  Volume : 21  |  Issue : 2  |  Page : 125-126

Diclofenac suppository administration in conjunction with lidocaine gel during transrectal ultrasound-guided prostate biopsy

Department of Urology, Christian Medical College, Vellore, Tamil Nadu, India

Correspondence Address:
J Chandra Singh
Department of Urology, Christian Medical College,Vellore 632 004, Tamilnadu
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Source of Support: None, Conflict of Interest: None

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How to cite this article:
Chandra Singh J, Kekre NS. Diclofenac suppository administration in conjunction with lidocaine gel during transrectal ultrasound-guided prostate biopsy. Indian J Urol 2005;21:125-6

How to cite this URL:
Chandra Singh J, Kekre NS. Diclofenac suppository administration in conjunction with lidocaine gel during transrectal ultrasound-guided prostate biopsy. Indian J Urol [serial online] 2005 [cited 2023 Feb 7];21:125-6. Available from:

Diclofenac suppository administration in conjunction with lidocaine gel during transrectal ultrasound-guided prostate

biopsy: prospective, randomized, placebo-controlled study. Urology. 2005 Oct;66:799-802. Irer B, Gulcu A, Aslan G, Goktay Y, Celebi I.

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This is a randomised controlled trial to assess the added efficacy of diclofenac suppository to transrectal lignocaine gel instillation in a group of 40 men. Elevated PSA or abnormal DRE were the indications for TRUS guided prostate biopsy. The study group received a 100 mg diclofenac suppository 1 h before biopsy and the control group was given a glycerin suppository as a placebo intrarectally 1 h before biopsy. All patients received intrarectal 10 ml of a 2% lidocaine gel 10 min before biopsy. Pain assessment was done using a self-administrated 10-point visual analog scale at baseline, at the end of biopsy, 2 h after the biopsy, and 1 day after the biopsy. Baseline characteristics were comparable. Pain scores of the diclofenac group were found to be significantly lower than those of the placebo group. The mean scores score in study and control group was 3.4 1.3 vs. 5.9 1.7 ( P < 0.0001), respectively, at the end of the biopsy. The mean pain score at 2 h and 1 day after the procedure was 1.2 1.0 vs. 3.6 1.4 ( P < 0.0001) and 0.5 0.9 vs. 1.4 1.3 ( P = 0.017) in the study and control group, respectively.

In this study, the pain scores were found to be lower in the study group than in the control group. A limitation of this study, as noted by the authors, was its small sample size. Another significant finding was that the diclofenac group had a greater number of patients with bleeding complications, such as rectal bleeding and haematuria but none required admission or intervention. It is difficult to say from the small sample size whether this is significant. This may be due to the platelet dysfunction induced by the NSAID.[1]

TRUS-guided prostate biopsy has emerged as the preferred method and is widely used in the diagnosis of prostate cancer. This diagnostic procedure is invasive and painful, and it may have to be repeated.[2] Up to a quarter of patients find the procedure moderately painful or worse, without analgesia, and nearly a fifth have significant complications, such as voiding difficulties, haematuria, haematospermia and infection.[3]

Effectiveness of intrarectal diclofenac administration on pain control during TRUS-guided prostate biopsy was shown by Haq et al.[4] In this study, diclofenac suppository has been found to have additional analgesic efficacy with lidocaine gel instillation in patients who underwent TRUS-guided prostate biopsy. Periprostatic infiltration of local anaesthetic has been established in several studies, including well powered prospective randomised placebo-controlled trials.[5],[6] In a randomised study Mallick et al.[7] showed no difference in pain relief between topical and infiltrated local anaesthesia during the biopsy, and much less pain during administration in the topical group. Though successful pain control is essential in making TRUS-guided prostate biopsy tolerable, few urologists used pain-controlling techniques.[8] As TRUS guided biopsy is being performed for various indications including PSA screening, early diagnosis of suspicious nodules, follow up of patients on watchful waiting protocol and following radiotherapy, better analgesia will improve compliance and make it more tolerable.

   References Top

1.Power I, Chambers WA, Greer IA, Ramage D, Simon E.Platelet function after intramuscular diclofenac. Anaesthesia 1990;45:916-9.  Back to cited text no. 1  [PUBMED]  
2.Luscombe CJ, Cooke PW.Pain during prostate biopsy. Lancet 2004;363:1840-1.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Crundwell MC, Cooke PW, Wallace DM.Patients' tolerance of transrectal ultrasound-guided prostatic biopsy: an audit of 104 cases. BJU Int 1999;83:792-5.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Haq A, Patel HR, Habib MR, Donaldson PJ, Parry JR.Diclofenac suppository analgesia for transrectal ultrasound guided biopsies of the prostate: a double-blind, randomized controlled trial. J Urol 2004;171:1489-91.  Back to cited text no. 4    
5.Lynn NN, Collins GN, Brown SC, O'Reilly PH.Periprostatic nerve block gives better analgesia for prostatic biopsy. BJU Int 2002;90:424-6.  Back to cited text no. 5    
6.Ozden E, Yaman O, Gogus C, Ozgencil E, Soygur T.The optimum doses of and injection locations for periprostatic nerve blockade for transrectal ultrasound guided biopsy of the prostate: a prospective, randomized, placebo controlled study. J Urol 2003;170:2319-22.  Back to cited text no. 6    
7.Mallick S, Humbert M, Braud F, Fofana M, Blanchet P. Local anesthesia before transrectal ultrasound guided prostate biopsy: comparison of 2 methods in a prospective, randomized clinical trial. J Urol 2004;171:730-3.  Back to cited text no. 7    
8.Davis M, Sofer M, Kim SS, Soloway MS.The procedure of transrectal ultrasound guided biopsy of the prostate: a survey of patient preparation and biopsy technique. J Urol 2002;167:566-70.  Back to cited text no. 8    


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