***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: 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 prospect ively r and omized 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 Introduction : To test the hypothesis that periprostatic block could completely relief  prostatic biopsy-associated pain . Material s and Methods : Patients scheduled for transrectal ultrasound guided prostate biopsy  were r and omized ( 1:1:1 ratio ) to no analgesia ( group A ) , endorectal enema of 1 % lidocaine gel ( group B ) or transrectal periprostatic block ( group C ) . All patients underwent 10 core TRUS-guided biopsy .  After the procedure , a ten visual analogue pain score ( VAS ) from 0 = no discomfort to 10 = severe pain was administered to the biopsied patients and a global estimation of pain associated with the procedure was obtained . The study design included interim analysis of pain score after the first 60 patients were enrolled . Kruskal-Wallis test for unpaired data was used for statistical analysis . Data are presented as mean , median ( range ) . Results : Sixty patients were enrolled between May 2003 and December 2003 and all patients were evaluable . Mean and median age was 68.5 and 69 ( range 53–82 ) years , respectively .  Mean and median PSA was 86.8 and 9 ng/ml ( range 0.58–4.111 ) , respectively . No major side effects were observed . Patients in group A scored at VAS a median 4 , mean 5.5 ± 2.3 ( range 3–10 ) . Patients in group B scored a median 4 , mean 5.5 ± 2.7 ( range 3–10 ) ( p = 0.237 ) . Patients receiving periprostatic injections of carbocaine ( group C ) scored a median 0 , mean 0.5 ± 0.8 ( range 0–2 ) . The level of pain reported by this group of patients was significantly different from those reported by patients who performed prostatic biopsy without anesthesia or with intrarectal anesthetic jelly ( p = 0.00001 ) . In the periprostatic block group 65 % of patients referred no pain after the procedure ( VAS = 0 ) while all patients in the other groups experience some degree of pain . Conclusion : The use of bilateral periprostatic block is a very effective and useful technique , well tolerated by the patient , which almost completely abolishes the pain and discomfort associated with the prostatic biopsy procedure AIM This study was design ed to compare the effectiveness of intrarectal lidocaine gel versus periprostatic lidocaine injection during transrectal ultrasound (TRUS)-guided prostate biopsy . METHODS Ninety men undergoing transrectal prostate biopsy from July through December 2004 were r and omized into three groups of 30 patients each . Before the biopsy , patients in Group 1 received 20 mL of 2 % lidocaine gel intrarectally ; patients in Group 2 received 5 mL ( 2.5 mL per side ) of 2 % lidocaine solution injected near the junction of the seminal vesicle with the base of the prostate ( along the neurovascular bundles ) , and patients in Group 3 ( control group ) received 5 mL ( 2.5 mL per side ) of normal saline injected along the neurovascular bundles . Pain level after the biopsy was assessed using a 10-point linear visual analog scale ( VAS ) . Results were statistically compared by the Wilcoxon Rank Sum test . RESULTS Patients in Group 2 had significantly lower VAS scores than those in Group 3 ( 3.6 + /- 2.1 vs 5.8 + /- 1.9 , P < 0.0001 ) , but those in Group 1 did not ( 5.5 + /- 2.7 vs 5.8 + /- 1.9 , P = 0.67 ) . Gross hematuria , rectal bleeding , and hemospermia occurred in 36 ( 40.0 % ) , 6 ( 7 % ) and 5 ( 6 % ) patients . One patient had temporary vasovagal syncope . No patient reported febrile urinary tract infection or urinary retention . CONCLUSIONS Periprostatic injection of local anaesthetic is a safe technique that significantly reduces pain during prostate biopsy , whereas intrarectal lidocaine injection did not reduce pain . This safe , simple technique should be applied in men undergoing TRUS-guided prostate biopsy to limit patient discomfort INTRODUCTION Studies have demonstrated the need for pain control during multiple transrectal prostate biopsies . Due to encountered published results on periprostatic nerve block , we prospect ively evaluated the efficacy and safety of periprostatic local anaesthesia at the apex in comparison to intrarectal lidocaine gel . METHODS From January 2001 to January 2002 110 patients underwent prostate biopsy . Patients were r and omized to receive 10 cc of either 2 % lidocaine gel intrarectally ( Group 1 ) or 10 cc of 1 % lidocaine solution injected under ultrasound guidance for bilateral periprostatic nerve block at the apex ( Group 2 ) . Pain during biopsy was assessed using a 10-point linear visual analog pain scale and a 5-point digital visual pain scale ( continuous variables ) . Statistical analysis of pain scores was performed using the Student t-test . RESULTS 96 patients fitted the inclusion and presented no exclusion criteria . 43 patients composed group 1 , and 53 patients group 2 . The mean pain score was 2.76+/-1.69 and 1.73+/-1.26 for group 1 and 2 , respectively for the 10-point linear visual analog pain scale ( p=0.001 ) . The mean pain score was 2.26+/-0.82 and 1.62+/-0.56 for groups 1 and 2 , respectively for the 5-point digital visual pain scale ( p<0.001 ) . There was no difference in mean patient age ( p=0.348 ) , prostate size ( p=0.899 ) , serum PSA ( p=0.932 ) , and complications when comparing both groups . The number of biopsies per patient was significantly higher in group 2 ( p=0.006 ) , but pain scores in each scale were significantly less . CONCLUSIONS Periprostatic nerve block at the apex is superior to intrarectal lidocaine gel for controlling pain during transrectal prostate biopsy , with no increased complications . This technique should be recommended for those patients without anal or rectal inflammatory diseases OBJECTIVES To evaluate the effect of periprostatic infiltration with local anesthesia on the level of discomfort associated with transrectal ultrasound-guided needle biopsy of the prostate .  Transrectal ultrasound-guided needle biopsy of the prostate is the st and ard procedure to diagnose prostate cancer . METHODS A prospect i ve , r and omized , double-blind study was performed on 100 men referred for biopsy of the prostate . Fifty subjects were r and omized to periprostatic injection of 10 mL of 2 % lidocaine solution without epinephrine , and 50 were r and omized to injection of placebo ( 10 mL of 0.9 % NaCl ) . Each subject completed three 10-point visual analog scales for pain after a series of 15 needle biopsies . Pain was rated during the biopsy , diagnostic investigation , and injection of lidocaine . RESULTS Patients who received local anesthesia had significantly lower visual analog scale scores compared with the group without lidocaine during the biopsy ( mean score 0.76 versus 3.62 , P < 0.001 ) and diagnostic examination ( mean score 1.08 versus 1.86 , P = 0.025 ) . Lidocaine injection caused no adverse effects . CONCLUSIONS Periprostatic injection of lidocaine represents a simple and safe procedure that significantly reduces discomfort during probe manipulation and biopsy . We recommend this procedure in men undergoing transrectal ultrasound-guided prostate biopsy OBJECTIVE To assess the benefit of the periprostatic administration of lidocaine previously to ultrasound-guided prostate biopsy . MATERIAL S AND METHODS In the period from April to October 2002 , forty patients underwent ultrasound-guided prostate biopsy due to increased PSA or abnormal digital rectal examination . A r and omized double-blind study was performed , where the patients received an injection of lidocaine 2 % or saline solution , in a total of 10 ml periprostatic . Immediately following the biopsy , the pain associated to the procedure was assessed , using a visual analogical scale from 0 to 10 . The mean number of fragments collected per patient in the biopsies was 11.3 . The statistical analysis used for assessment of pain was the Student 's t , with p < 0.05 being significant . RESULTS The groups were homogeneous concerning the anthropometrical data . In relation to pain , those patients in the groups that underwent biopsy with the use of lidocaine presented a maximum score of 6 , while in the group that underwent biopsy with the use of saline solution , 4 patients presented score 7 ou 8 . The mean score and st and ard deviation with lidocaine were 2.55 + /- 2.34 ( CI 95 % = 1.53 to 3.57 ) and with saline solution were 3.75 + /- 2.52 ( CI 95 % = 2.66 + /- 4.84 ) with no statistical significant difference between the groups . CONCLUSION The lidocaine injection did not show statistical difference when compared with saline solution in the periprostatic blockade during echo-guided prostate biopsy Purpose Transrectal ultrasound-guided prostate biopsy is the procedure of choice for diagnosing prostate cancer . We compared with pain-relieving effect of acetaminophen , a known drug for enhancing the pain-relieving effect of tramadol , and eutectic mixture of local anesthetics ( EMLA ) , a local anesthetic agent , with that of the conventional periprostatic nerve block method . Material s and Methods This was a prospect i ve , r and omized , single-blinded study . A total of 430 patients were r and omly assigned to three groups . Group 1 received a periprostatic nerve block with 1 % lidocaine , group 2 received acetaminophen 650 mg , and group 3 received EMLA cream for pain control . All patients were given 50 mg of tramadol intravenously 30 minutes before the procedure . At 3 hours after completion of the procedure , the patients were asked to grade their pain on a horizontal visual analogue scale ( VAS ) . The patients were also asked whether they were willing to undergo future biopsy if required . Results There were no significant differences between the three groups in terms of age , prostate-specific antigen , prostate size , or numbers of biopsy cores . The pain scores for groups 2 and group 3 , which were 3.47±1.92 and 3.50±1.36 , respectively , were similar and were significantly lower than that of group 1 , which was 5.24±2.07 . Conclusions Acetaminophen and EMLA cream with intravenous injection of tramadol are safe , easy , and effective methods of controlling pain during the procedure . These methods were more effective for pain relief than was the conventional periprostatic nerve block method AIM Transrectal ultrasound ( TRUS ) guided prostete biopsy is accepted as a st and ard procedure in the diagnosis of prostate cancer . Many different protocol es are applied to reduce the pain during the process . In this study we aim ed to the comparison of two procedure with intrarectal lidocaine gel and periprostatice nerve blockade respective- ly in addition to perianal intrarectal lidocaine gel on the pain control in prostate biop- sy by TRUS . METHODS 473 patients who underwent prostate biopsy guided TRUS between 2008 - 2012 were included in the study . 10-point linear visual 
    Output:
    
Conclusions The blockage of the periprostatic plexus in the performance of a transrectal ultrasound-guided prostatic biopsy , alone or in combination with intrarectal analgesia or sedation , is an effective method to reduce pain