Analgesia for Prostate biopsy: efficacy of Diclofenac patch versus Diclofenac suppository as compared to Placebo during Prostate biopsy

Kishore Adiyat; Prashanth Kanagarajah; Antony PG; Suresh Bhat

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Analgesia for Prostate biopsy: efficacy of Diclofenac patch versus Diclofenac suppository as compared to Placebo during Prostate biopsy

Author(s):

Kishore Thekke Adiyat^1,*,

Prashanth Kanagarajah²,

Antony PG³,

Suresh Bhat³

11West Fort Hospital Punkunnam Road Thrissur, kishoreta@yahoo.com, India

2Madras Medical College E.V.R. Periyar Salai Chennai, India

3West Fort Hospital Punkunnam Road Thrissur, India

Nephro-Urology Monthly:Vol. 2, issue 1; 239-243

Article type:Research Article

Received:Jun 12, 2009

Accepted:Jul 10, 2009

How to Cite:Kishore Thekke AdiyatPrashanth KanagarajahAntony PGSuresh BhatAnalgesia for Prostate biopsy: efficacy of Diclofenac patch versus Diclofenac suppository as compared to Placebo during Prostate biopsy.Nephro-Urol Mon.2(1):239-243.

Abstract

Background and Aims: Trans-rectal ultrasound guided prostate biopsy (TRUS) remains the gold standard to diagnose patients with prostate cancer. The purpose of this study is to prospectively evaluate the efficacy of diclofenac suppository versus diclofenac patch as compared to placebo, on pain reduction during prostate biopsy.

Methods: A prospective, randomized, single-blind, placebo controlled study was performed in 73 patients requiring transrectal ultrasound guided prostate biopsy (TRUS). Patients were randomly allocated to receive 100 mg diclofenac suppository or 100 mg diclofenac patch or matching placebo 1 hour prior to the procedure. They were asked to indicate on a 10 cm visual analogue scale the degree of discomfort during probe insertion, needle penetration and four hours post biopsy. Statistical analysis was done using one way ANOVA. The data was analyzed using SPSS version 10.0.

Results: Patients given diclofenac suppository and diclofenac patch had statistically significant lower four hour pain scores than those who were given placebo. There was no statistically significant difference in the pain scores between the three groups during probe insertion and needle penetration. The three groups were similar in regards to age, prostate volume, biopsy number, prostate specific antigen levels, histological diagnosis and complication rate.

Conclusions: Diclofenac in the form of a patch or suppository does not confer a superior intraprocedural analgesic effect compared to placebo, but it reduces post procedural pain to a significant extent. We do not recommend its use as a single agent analgesic for prostate biopsy but it should be used as an adjunctive analgesic for reducing post procedural pain.

Keywords

Prostate Biopsy

Prostate Cancer

Trans-Rectal Ultrasound Guided Biopsy

Local Analgesia

Local Anesthesia

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