comparative evaluation of periprostatic nerve block and diclofenac patch in transrectal ultrasound-guided prostatic needle biopsy

background the aim of the present study was to compare two analgesic techniques for transrectal ultrasound (trus)-guided biopsy: diclofenac patch versus periprostatic nerve block with 1% lidocaine. objectives to study the efficacy of and compare diclofenac patch and periprostatic nerve block as analgesia in trus-guided prostate needle biopsy. patients and methods in total, 60 patients were prospectively randomized into three groups: those in whom a diclofenac patch was used (n = 20), those in whom periprostatic nerve block was used (n = 20), and a control group (n = 20). prostate biopsy was performed after administration of analgesia according to group. results the three groups were similar in terms of age, prostate volume, and psa (prostate-specific antigen) levels. pain scores were significantly lower in the nerve block group (p = 0.000) at the time of biopsy until 2 h postprocedure, but not at 4 h postprocedure (p = 0.068). no significant difference in pain score was observed in the diclofenac patch group at the time of biopsy (p = 0.106) as compared to the control group, but the diclofenac patch provided adequate pain relief 1 h (p = 0.000), 2 h (0.000), and 4 h (0.002) postprocedure. no significant difference was observed in pain score between the nerve block (p = 0.520) and control groups (0.057) at probe insertion. the pain score at 4 h was significantly lower in the patch group compared to the nerve block and control groups. conclusions periprostatic nerve block provides superior analgesia for trus-guided biopsy. diclofenac patch is useful as an adjunct.