• Syed Iftikhar Alam
  • Hazrat ullah
  • Zeeshan Kibria
  • Iqra Masood
  • Rubab Jawed


Background: Transrectal ultrasound (TRUS) technique for getting prostatic tissue for histopathology is now the standard procedure for malignant lesions of the prostate and imperative diagnostic investigation of patients with clinical specks of prostatic neoplasia. During TRUS guided biopsy, pain control has been important issue therefore, highly potent analgesia before this procedure should be considered on high priority according to current census. Therefore, we compared intramuscular diclofenac injection with sensory blockade of injection lidocaine to abolish pain undergoing prostatic biopsy with TRUS technique. Methods: Total 200 patients were selected for this study having raised PSA values and suspicious nodule on Digital Rectal Examination. These patients were segregated into two groups by randomization. Group “A” received intramuscular diclofenac and group “B” were infiltrated with lidocaine injection for sensory blockade. Results: Patients in group A was having mean age of 64.5±5.8 years while for group B patients was 65.6±4.9 years (p=0.16). Both groups have statistically insignificant difference in their mean PSA values (p=0.24) and mean prostatic volume (p=0.22). The mean pain scores on visual analogue scale in groups A was 3.5±0.8 and in group B it was 2.4±0.8 (p<0.001). 60% group A patients reported with mild or no pain compared to 90% in group B. (p<0.001). Conclusion: Local blockade with lidocaine injection has better pain control as compared to patients experienced pain with intramuscular diclofenac used for prostatic biopsy through TRUS technique.Keywords: Transrectal Ultrasound; Biopsy; Periprostatic block; Diclofenac; Lidocaine; Prostate

Author Biography

Syed Iftikhar Alam



Adamakis I, Mitropoulos D, Haritopoulos K, Alamanis C, Stravodimos K, Giannopoulos A. Pain during transrectal ultrasonography guided prostate biopsy: a randomized prospective trial comparing periprostatic infiltration with lidocaine with the intrarectal instillation of lidocaine-prilocain cream. World J Urol 2004;22(4):281–4.

Ukimura O, Coleman JA, de la Taille A, Emberton M, Epstein JI, Freedland SJ, et al. Contemporary role of systematic prostate biopsies: indications, techniques, and implications for patient care. Eur Urol 2013;63(2):214–30.

Irani J, Fournier F, Bon D, Gremmo E, Dore B, Aubert J. Patient tolerance of transrectal ultra-sound-guided biopsy of the prostate. Br J Urol 1997;79(4):608–10.

Al-Ghazo MA, Ghalayini IF, Matalka II. Ultrasound-guided transrectal extended prostate biopsy: a prospective study. Asian J Androl 2005;7(2):165–9.

Carroll P, Shinohara K. Transrectal ultrasound guided prostate biopsy. Tech Rep Dept Urol 2010.

Bingqian L, Peihuan L, Yudong W, Jinxing W, Zhiyong W. Intraprostatic local anesthesia with periprostatic nerve block for transrectal ultrasound guided prostate biopsy. J Urol 2009;182(2):479–83.

Obek C, Ozkan B, Tunc B, Can G, Yalcin V, Solok V. Comparison of 3different methods of anesthesia before transrectal prostate biopsy: a prospective randomized trial. J Urol 2004;172(2):502–5.

Hodge KK, McNeal JE, Terris MK, Stamey TA. Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate. J Urol 1989;142(1):71–4.

Presti JC Jr, O’Dowd GJ, Miller MC, Mattu R, Veltri RW. Extended peripheral zone biopsy schemes increase cancer detection rates and minimize variance in prostate specific antigen and age related cancer rates: results of a community multi-practice study. J Urol 2003;169(1):125–9.

Stewart CS, Leibovich BC, Weaver AL, Lieber MM. Prostate cancer diagnosis using a saturation needle biopsy technique after previous negative sextant biopsies. J Urol 2001;166(1):86–91.

Grummet J, Davis P. Current practices of prostate biopsy in Australia and New Zealand–The survey. BJU Int 2013;111:96.

Leibovici D, Zisman A, Siegel YI, Sella A, Kleinmann J, Lindner A. Local anesthesia for prostate biopsy by periprostatic lidocaine injection: a double-blind placebo controlled study. J Urol 2002;167(2 Pt 1):563–5.

Walker AE, Schelvan C, Rockall AG, Rickards D, Kellett MJ. Does pericapsular lignocaine reduce painduring transrectal ultrasonography-guided biopsy of the prostate? BJU Int 2002;90(9):883–6.

Nash PA, Bruce JE, Indudhara R, Shinohara K. Transrectal ultrasound guided prostatic nerve blockade eases systematic needle biopsy of the prostate. J Urol 1996;155(2):607–9.

Liu LR, Han P, Zhu YC, Wei X, Yuan H, Zheng S, et al. A systematic review and meta-analysis comparing three methods of anesthesia for transrectal ultrasound guided prostate biopsy: periprostatic nerve block, intrarectal topical anesthesia and their combination. J Urol 2012;187(4):e832.

Autorino R, De Sio M, Di Lorenzo G, Damiano R, Perdona S, Chindolo L, et al. How to decrease pain during transrectal ultrasound guided prostate biopsy: a look at the literature. J Urol 2005;174(6):2091–7.

Alavi AS, Soloway MS, Vaidya A, Lynne CM, Gheiler EL. Local anesthesia for ultrasound guided prostate biopsy: a prospective randomized trial comparing 2 methods. J Urol 2001;166(4):1343–5.

Seymour H, Perry MJ, Lee‐Elliot C, Dundas D, Patel U. Pain after transrectal ultrasonography‐guided prostate biopsy: the advantages of periprostatic local anaesthesia. BJU Int 2001;88(6):540–4.

Addla SK, Adeyoju AA, Wemyss-Holden GD, Neilson D. Local anaesthetic for transrectal ultrasound-guided prostate biopsy: a prospective, randomized, double blind, placebo-controlled study. Eur Urol 2003;43(5):441–3.