1
|
Lai HC, Chen CL, Huang YH, Wu KL, Huang RC, Lin BF, Chan SM, Wu ZF. Comparison of 2 effect-site concentrations of remifentanil with midazolam during transrectal ultrasound-guided prostate biopsy under procedural analgesia and sedation: A randomized controlled study. Medicine (Baltimore) 2022; 101:e30466. [PMID: 36086764 PMCID: PMC10980449 DOI: 10.1097/md.0000000000030466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 08/02/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Until now, target-controlled infusion of remifentanil with midazolam for transrectal ultrasound-guided prostate biopsy has not been described. Here, we investigate 2 effect-site concentrations of remifentanil with intermittent bolus midazolam for transrectal ultrasound-guided prostate biopsy under procedural analgesia and sedation. METHODS A prospective, randomized controlled trial including patients who received a transrectal ultrasound-guided prostate biopsy between February 2019 and January 2021 was conducted. Group 1 and Group 2 were respectively administered an initial effect-site concentration of remifentanil of 1.0 ng/mL and 2.0 ng/mL by a target-controlled infusion pump with Minto model. In both groups, maintenance of the effect-site concentration of remifentanil was adjusted upward and downward by 0.5 ng/mL to keep patient comfort with acceptable pain (remaining moveless), and mean arterial pressure and heart rate within baseline levels ± 30%, and using intermittent bolus midazolam to keep the Observer's Assessment of Alertness/Sedation scale between 2 and 4. The primary outcome was to determine which effect-site concentration of remifentanil provide adequate patient comfort with acceptable pain (remaining moveless) during the procedure. RESULTS A total of 40 patients in Group 1 and 40 patients in Group 2 were eligible for analysis. Most parameters were insignificantly different between Group 1 and Group 2, except Group 1 having higher peripheral oxygen saturation while probe insertion compared with Group 2. Group 2 patients had less intraoperative movements affecting the procedure (2 vs 18; P < .001), and less total times of target-controlled infusion pump adjustment (0 [0-1] vs 1 [0-3], P < .001) compared with group 1. However, group 1 patients had less apnea with desaturation (peripheral oxygen saturation < 90%; 0 vs 9, P = .002) and less remifentanil consumption (94.9 ± 25.5 μg vs 106.2 ± 21.2 μg, P = .034) compared to Group 2. CONCLUSION In transrectal ultrasound-guided prostate biopsy, target-controlled infusion with remifentanil Minto model target 2.0 ng/mL with 3 to 4 mg midazolam use provided sufficient analgesia and sedation, and appropriate hemodynamic and respiratory conditions.
Collapse
Affiliation(s)
- Hou-Chuan Lai
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chin-Li Chen
- Division of Urological Surgery, Department of Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Yi-Hsuan Huang
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Ke-Li Wu
- Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Ren-Chih Huang
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Bo-Feng Lin
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Shun-Ming Chan
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Zhi-Fu Wu
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China
- Department of Anesthesiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China
- Center for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, Republic of China
| |
Collapse
|
2
|
Suksompong S, Limratana P, Saengsomsuan N, Wongsawang N, Chaikittisilpa N. Propofol with or without fentanyl for pain relief after transrectal ultrasound-guided prostate (TRUS-P) biopsy: a randomized controlled study. Braz J Anesthesiol 2021; 71:345-351. [PMID: 34229860 PMCID: PMC9373581 DOI: 10.1016/j.bjane.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 07/11/2020] [Indexed: 11/24/2022] Open
Abstract
Background Postoperative pain from transrectal ultrasound-guided prostate (TRUS-P) biopsy under sedation is often mild. Benefit of opioids used during sedation is controversial. Objective The objective was to compare numeric rating scale (NRS) score at 30 minutes after TRUS-P biopsy between patients receiving propofol alone or with fentanyl. Methods We randomly allocated 124 patients undergoing TRUS-P biopsy to receive either fentanyl 0.5 mcg.kg-1 (Group F) or normal saline (Group C). Both groups received titrated propofol sedation via Target-controlled infusion (TCI) with Schneider model until the Observer's Assessment of Alertness/Sedation (OAA/S) scale 0–1 was achieved. Hemodynamic variables, patient movement, postoperative pain score, patient and surgeon satisfaction score were recorded. Results Overall, most patients (97.5%) had no to mild pain. Group F had significantly lower median NRS score at 30 minutes compared to Group C (0 [0, 0] vs. 0 [0, 0.25], p = 0.039). More patients in Group C experienced pain (90% vs. 75.8%, p = 0.038). Perioperative hypotension was higher in group F (81.7%) compared to Group C (61.3%) (p = 0.013). Thirty-five (56.5%) patients in Group F and 25 (42.7%) patients in Group C had movement during the procedure (p = 0.240). Surgeon’s satisfaction score was higher in Group F (10 [9, 10]) than Group C (9 [9, 10]) (p = 0.037). Conclusion Combining low dose fentanyl with TCI propofol sedation may provide additional benefit on postoperative pain after TRUS-P biopsy, but results in perioperative hypotension. Fentanyl may attenuate patient movement during the procedure, which leads to greater surgeon’s satisfaction.
Collapse
Affiliation(s)
- Sirilak Suksompong
- Mahidol University, Faculty of Medicine Siriraj Hospital, Department of Anesthesiology, Bangkok, Thailand
| | - Panop Limratana
- Mahidol University, Faculty of Medicine Siriraj Hospital, Department of Anesthesiology, Bangkok, Thailand.
| | - Niruji Saengsomsuan
- Mahidol University, Faculty of Medicine Siriraj Hospital, Department of Anesthesiology, Bangkok, Thailand
| | - Nattaporn Wongsawang
- Mahidol University, Faculty of Medicine Siriraj Hospital, Department of Anesthesiology, Bangkok, Thailand
| | - Nophanan Chaikittisilpa
- Mahidol University, Faculty of Medicine Siriraj Hospital, Department of Anesthesiology, Bangkok, Thailand
| |
Collapse
|
3
|
Demirtaş A, Sönmez G, Tombul ŞT, Demirtaş T. Comparison of pain levels in fusion prostate biopsy and standard TRUS-Guided biopsy. Int Braz J Urol 2020; 46:557-562. [PMID: 32213209 PMCID: PMC7239274 DOI: 10.1590/s1677-5538.ibju.2019.0154] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 10/06/2019] [Indexed: 11/30/2022] Open
Abstract
Objectives Fusion prostate biopsy (FPB) has recently emerged as a popular and successful biopsy technique on diagnosis of prostate cancer. The aim of this study was to compare the pain levels in TRUS-guided standard 12-core prostate biopsy (SPB) and MpMRI-guided FPB. Materials and Methods Patients detected with a PI-RADS (Prostate Imaging Reporting and Data System) ≥3 lesion on MpMRI underwent MpMRI-guided FPB (Group I) and the patients who had no suspected lesions or had a PI-RADS <3 lesion on MpMRI underwent TRUS-guided SPB (Group II). Pain assessment was performed using Visual Analog Scale (VAS) five minutes after the procedure. Following the procedure, the patients were asked to indicate the most painful biopsy step among the three steps. Results 252 patients were included in this study (Group I=159, Group II=93). The mean number of cores and the malignancy detection rate were significantly higher in Group I compared to Group II (p <0.001, p=0.043, respectively). No significant difference was found between the two groups with regard to VAS scores (p=0.070). The most painful part of the whole procedure was revealed to be the insertion of the probe into the rectum. However, no significant difference was found between the two groups with regard to the most painful biopsy step (p=0.140). Conclusion FPB, with a relatively higher cancer detection rate, leads to the same pain level as SPB although it increases the number of biopsy cores and involves a more complex procedure compared to SPB. Further prospective studies with larger patient series are needed to substantiate our findings.
Collapse
Affiliation(s)
| | - Gökhan Sönmez
- Department of Urology, Kayseri City Hospital, Kayseri, Turkey
| | | | - Türev Demirtaş
- Department of Medical History and Ethics, Erciyes University, Kayseri, Turkey
| |
Collapse
|
4
|
Tolani MA, Ahmed M, Lawal AT, Fidelis L, Sudi A, Hamza BK, Awaisu M, Nasir O, Bello A, Maitama HY. Comparison of the tolerability and efficacy of intra-rectal lidocaine gel with peri-prostatic nerve block as anaesthetic techniques for prostate biopsy. AFRICAN JOURNAL OF UROLOGY 2020. [DOI: 10.1186/s12301-020-00038-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
Background
Prostate biopsy is a painful procedure. However, over the years, varied opinions exist among urologists about the methods of achieving optimal pain relief for the procedure. The purpose of this study was to compare the tolerability of administration and the efficacy of intra-rectal lidocaine gel with peri-prostatic nerve block for this procedure.
Methods
From June 2016 to June 2017, 110 patients who met the study criteria were randomized to receive either intra-rectal lidocaine gel (Group 1) or an apical peri-prostatic nerve block (Group 2) for prostate biopsy. Their level of pain perception during the anaesthesia administration and the prostate biopsy was assessed using the Numeric Rating Scale. Other biopsy-related complications and patient satisfaction were also evaluated. Grouped data were compared using student t test and Chi-square with p < 0.05 considered significant.
Results
The pain score during the administration of anaesthesia was 1.6 ± 1.9 and 3.7 ± 2.1 for the intra-rectal lidocaine gel and peri-prostatic nerve block groups, respectively (p = 0.001). However, during the prostate biopsy, the pain score was 6.8 ± 2.2 and 2.9 ± 1.9 for the intra-rectal lidocaine gel and peri-prostatic nerve block groups, respectively (p = 0.001). There was a significantly lower rate of satisfaction (45.3% versus 86.8%, p = 0.001) in the lidocaine gel group.
Conclusions
Although intra-rectal lidocaine gel administration is better tolerated by patients, a peri-prostatic nerve block is more effective and provides better patient satisfaction than intra-rectal lidocaine gel when used as anaesthesia for prostate biopsy.
Collapse
|
5
|
Lee MS, Moon MH, Kim CK, Park SY, Choi MH, Jung SI. Guidelines for Transrectal Ultrasonography-Guided Prostate Biopsy: Korean Society of Urogenital Radiology Consensus Statement for Patient Preparation, Standard Technique, and Biopsy-Related Pain Management. Korean J Radiol 2020; 21:422-430. [PMID: 32193890 PMCID: PMC7082664 DOI: 10.3348/kjr.2019.0576] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 12/12/2019] [Indexed: 11/15/2022] Open
Abstract
The Korean Society of Urogenital Radiology (KSUR) aimed to present a consensus statement for patient preparation, standard technique, and pain management in relation to transrectal ultrasound-guided prostate biopsy (TRUS-Bx) to reduce the variability in TRUS-Bx methodologies and suggest a nationwide guideline. The KSUR guideline development subcommittee constructed questionnaires assessing prebiopsy anticoagulation, the cleansing enema, antimicrobial prophylaxis, local anesthesia methods such as periprostatic neurovascular bundle block (PNB) or intrarectal lidocaine gel application (IRLA), opioid usage, and the number of biopsy cores and length and diameter of the biopsy needle. The survey was conducted using an Internet-based platform, and responses were solicited from the 90 members registered on the KSUR mailing list as of 2018. A comprehensive search of relevant literature from Medline database was conducted. The strength of each recommendation was graded on the basis of the level of evidence. Among the 90 registered members, 29 doctors (32.2%) responded to this online survey. Most KSUR members stopped anticoagulants (100%) and antiplatelets (76%) one week before the procedure. All respondents performed a cleansing enema before TRUS-Bx. Approximately 86% of respondents administered prophylactic antibiotics before TRUS-Bx. The most frequently used antibiotics were third-generation cephalosporins. PNB was the most widely used pain control method, followed by a combination of PNB plus IRLA. Opioids were rarely used (6.8%), and they were used only as an adjunctive pain management approach during TRUS-Bx. The KSUR members mainly chose the 12-core biopsy method (89.7%) and 18G 16-mm or 22-mm (96.5%) needles. The KSUR recommends the 12-core biopsy scheme with PNB with or without IRLA as the standard protocol for TRUS-Bx. Anticoagulants and antiplatelet agents should be discontinued at least 5 days prior to the procedure, and antibiotic prophylaxis is highly recommended to prevent infectious complications. Glycerin cleansing enemas and administration of opioid analogues before the procedure could be helpful in some situations. The choice of biopsy needle is dependent on the practitioners' situation and preferences.
Collapse
Affiliation(s)
- Myoung Seok Lee
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Min Hoan Moon
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
| | - Chan Kyo Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Yoon Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Moon Hyung Choi
- Department of Radiology, The Catholic University of Korea, Eunpyeong St. Mary's Hospital, Seoul, Korea
| | - Sung Il Jung
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | | |
Collapse
|
6
|
Sonmez G, Tombul ST, Demirtas T, Demirtas A. Risk factors associated with pain in fusion prostate biopsy. Prostate Int 2020; 8:185-189. [PMID: 33425797 PMCID: PMC7767937 DOI: 10.1016/j.prnil.2020.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/07/2020] [Accepted: 05/12/2020] [Indexed: 12/24/2022] Open
Abstract
Background Multiparametric prostate magnetic resonance imaging (mpMRI)–guided fusion prostate biopsy is an emerging technique in the diagnosis of prostate cancer and provides extensive information on the prebiopsy anatomy of the prostate, anus, and rectum. We aimed to investigate the clinical and anatomical risk factors aggravating the pain experienced by patients undergoing mpMRI-guided fusion prostate biopsy. Methods The prospective study included 319 patients aged 45–75 years who had a prostate-specific antigen <10 ng/ml and a Prostate Imaging Reporting and Data System ≥3 lesion and underwent combined biopsy (targeted biopsy + 12-core standard prostate biopsy) under local anesthesia (intrarectal lidocaine gel + periprostatic nerve block). Immediately after the biopsy procedure, pain assessment was achieved using Visual Analog Scale (VAS). The relationship between the VAS and 13 clinical parameters was evaluated using ordinal logistic regression analysis. Results The 319 patients had a mean age of 62.39 ± 6.98 years and a median prostate-specific antigen level of 7.20 (range, 5.20–8.50) ng/ml. The VAS was found to be correlated with 4 of 13 parameters, including (i) a shorter prostate–anus surface distance (cutoff value, 55.5 mm), (ii) a narrower anorectal angle (cutoff value, 106.5°), (iii) a larger total prostate volume (cutoff, 61.6 mm3), and (iv) having no history of prior biopsy (biopsy-naive patients). Conclusion Anatomical measurements that can be achieved by using mpMRI images (TPV, PASD and ARA) may be useful in the identification of patients at an increased risk of pain during biopsy and also in taking analgesic precautions in such patients.
Collapse
Affiliation(s)
- Gokhan Sonmez
- Erciyes University, Department of Urology, Kayseri, Turkey
| | | | - Turev Demirtas
- Erciyes University, Department of Medical History and Ethics, Kayseri, Turkey
| | | |
Collapse
|
7
|
Diniz ALL. Editorial Comment: Comparison of pain levels in fusion prostate biopsy and standard TRUS-Guided biopsy. Int Braz J Urol 2020; 46:563-565. [PMID: 32374122 PMCID: PMC7239299 DOI: 10.1590/s1677-5538.ibju.2019.0154.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Andre Luiz Lima Diniz
- Instituto Nacional do Cancer - INCA, Rio de Janeiro, RJ, Brasil.,Hospital Federal da Lagoa, Rio de Janeiro, RJ, Brasil
| |
Collapse
|
8
|
Kim DK, Lee JY, Jung JH, Hah YS, Koo KC, Lee KS, Chung BH, Cho KS. What is the most effective local anesthesia for transrectal ultrasonography-guided biopsy of the prostate? A systematic review and network meta-analysis of 47 randomized clinical trials. Sci Rep 2019; 9:4901. [PMID: 30894638 PMCID: PMC6426994 DOI: 10.1038/s41598-019-41412-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 03/08/2019] [Indexed: 11/09/2022] Open
Abstract
We aimed to compare the effectiveness of various local anesthetic methods for controlling prostate biopsy (PBx) related pain using network meta-analysis. Literature searches were performed on PubMed/Medline, Embase, and Cochrane Library up to March 2018. Forty-seven randomized controlled trials, in which the effectiveness of PBx-related pain was investigated using a visual analogue scale after various local anesthetic methods, were included. The local anesthetic methods included intraprostatic local anesthesia (IPLA), intrarectal local anesthesia (IRLA), intravenous sedation (IVS), periprostatic nerve block (PNB), pelvic plexus block (PPB), and spinal anesthesia (SPA). Eight pairwise meta-analyses and network meta-analyses with 21 comparisons were performed. All modalities, except single use of IPLA and IRLA, were more effective than placebo. Our results demonstrate that PNB + IVS (rank 1) and SPA (rank 2) were the most effective methods for pain control. The followings are in order of PPB + IRLA, PNB + IPLA, PPB, PNB + IRLA, IVS, and PNB. In conclusion, the most effective way to alleviate PBx-related pain appears to be PNB + IVS and SPA. However, a potential increase in medical cost and additional risk of morbidities should be considered. In the current outpatient setting, PPB + IRLA, PNB + IPLA, PPB, PNB + IRLA, and PNB methods are potentially more acceptable options.
Collapse
Affiliation(s)
- Do Kyung Kim
- Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joo Yong Lee
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae Hung Jung
- Department of Urology, Institute of Evidence Based Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Yoon Soo Hah
- Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyo Chul Koo
- Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kwang Suk Lee
- Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byung Ha Chung
- Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kang Su Cho
- Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
9
|
Sönmez MG, Kozanhan B, Demirelli E, Öztürk Sönmez L, Kara C. What should be done to minimize pain without any sexual function deterioration in transrectal prostate biopsy? Cent European J Urol 2018; 70:372-377. [PMID: 29410888 PMCID: PMC5791401 DOI: 10.5173/ceju.2017.1442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 10/05/2017] [Accepted: 10/07/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction The aim of this study was to find an ideal method for the application of a transrectal ultrasound-guided prostate biopsy (TRUS-Bx) without deteriorating patient comfort. Material and methods TRUS-Bx was applied in a total of 93 patients. Taking the application method into consideration, these patients were divided into three groups, each consisting of 31 patients. Methods applied for pain control in the different groups were compared (groups 1, 2 and 3). Age, prostate specific antigen (PSA), prostate volume, cancer detection rate, re-biopsy consent ratio, complication rates, visual analog scale (VAS), and International Index of Erectile Function (IIEF-5) scores were compared among the groups. Results Age, PSA, prostate volume, cancer detection rate, and fever complication rate were not statistically different between the three groups. However, a statistically significant difference was detected among the groups for the VAS measured during and after TRUS-Bx, re-biopsy consent ratio, and hematuria (p <0.001, p <0.001, p <0.001, and p = 0.027, respectively). There was no detected difference in pre-operation IIEF-5 scores, but the difference in IIEF-5 scores in the first month after the operation was significant (p = 0.116, p = 0.024, respectively). Conclusions Anal dilatation after the application of intrarectal topical anesthetic to provide anesthesia during TRUS-Bx and giving lidocaine hydrochloride with epinephrine for periprostatic nerve blockage (PNB) is a successful and effective method to maintain patient comfort, especially as it relates to pain control and sexual function. Anal dilatation seems to minimize any pain that may occur due to probe transition, and adding epinephrine as a vasopressor to the anesthetic agent chosen during the operation will be rather helpful for hemostasis control and pain that results from the needle.
Collapse
Affiliation(s)
- Mehmet Giray Sönmez
- Department of Urology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Betül Kozanhan
- Department of Anesthesiology and Reanimation, Konya Education and Research Hospital, Konya, Turkey
| | - Erhan Demirelli
- Department of Urology, Giresun Medical Faculty, Giresun University, Giresun, Turkey
| | - Leyla Öztürk Sönmez
- Department of Physiology, Selcuklu Medical School, Selcuk University, Konya, Turkey
| | - Cengiz Kara
- Medical Park Ankara Hospital, Department of Urology, Ankara, Turkey
| |
Collapse
|
10
|
Li M, Wang Z, Li H, Yang J, Rao K, Wang T, Wang S, Liu J. Local anesthesia for transrectal ultrasound-guided biopsy of the prostate: A meta-analysis. Sci Rep 2017; 7:40421. [PMID: 28079154 PMCID: PMC5227686 DOI: 10.1038/srep40421] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 12/06/2016] [Indexed: 11/09/2022] Open
Abstract
A meta-analysis was performed to evaluate the efficacy of local anesthesia in alleviating pain during prostate biopsy. We searched relevant articles in PubMed and Embase. The included studies should be randomized controlled trials (RCT) using local anesthesia to alleviate pain during biopsy, which was recorded by a pain scale. Analgesic efficacy of different local anesthesia techniques were analyzed, including intrarectal local anesthesia (IRLA), periprostatic nerve block (PNB), pelvic plexus block (PPB) and intraprostatic local anesthesia (IPLA). We included 46 RCTs. PNB significantly reduced pain score compared with placebo (-1.27 [95% confidence interval [95% CI] -1.72, -0.82]) or no injection (-1.01 [95% CI -1.2, -0.82]). IRLA with prilocaine-lidocaine cream could also reduced pain (-0.45 [95% CI -0.76, -0.15]), while the IRLA with lidocaine gel was not effective (-0.1 [95% CI -0.24, 0.04]). PNB lateral to the neurovascular bundle had better analgesic effect than at prostate apex (P = 0.02). Combination use of PPB and IRLA considerably alleviated pain of patients compared with the combination of PNB and IRLA (-1.32 [95% CI -1.59, -1.06]). In conclusion, local anesthesia could alleviate patients' pain during the prostate biopsy. PNB was not so effective as PPB.
Collapse
Affiliation(s)
- Mingchao Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Zhengyun Wang
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Hao Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Jun Yang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Ke Rao
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Tao Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Jihong Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| |
Collapse
|
11
|
Kucur M, Goktas S, Kaynar M, Apiliogullari S, Kilic O, Akand M, Gul M, Celik JB. Selective Low-Dose Spinal Anesthesia for Transrectal Prostate Biopsy: A Prospective and Randomized Study. J Endourol 2015; 29:1412-7. [PMID: 26176605 DOI: 10.1089/end.2015.0450] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To evaluate the use of spinal anesthesia by reducing anesthetic agent dose to provide better analgesia with minimal side effects without sacrificing the outpatient setting for prostate biopsy. In this study, efficacy and tolerability of selective low-dose spinal anesthesia versus intrarectal local anesthesia (IRLA) plus periprostatic nerve blockade (PPNB) were compared. METHODS Between September 2012 and April 2013, 100 patients, aged 40 to 80 years, prostate-specific antigen (PSA) ≥4 ng/mL, abnormal digital rectal examinations, and enrolled for biopsy were included in the present study. Ensuring double blindness, pain was assessed using the visual analog scale (VAS). Anal sphincter relaxation, patient satisfaction with the anesthesia technique, and motor response were evaluated. RESULTS Differences between the two groups, considering age, American Society of Anesthesiologist score, total PSA, prostate volume, anesthesia duration, and cancer presence, were not statistically significant. Pain experienced during probe insertion, biopsy, and 30 minutes after biopsy was significantly lower in the low-dose spinal anesthesia group (P < 0.0001). Anal sphincter relaxation degree was significantly higher in the spinal group (P < 0.001). Patient procedure-related overall satisfaction level was significantly higher in the spinal anesthesia group (P < 0.001). In the spinal anesthesia group, no motor blockade was observed. Between the two groups, no statistically significant difference was seen with regard to complications (P > 0.05). CONCLUSION Selective low-dose spinal anesthesia provides better pain relief than PPNB plus IRLA without sacrificing the day case setting in ambulatory practice. It is also associated with high patient satisfaction and willingness for a repeated biopsy without differences in procedure duration, tolerance, and complications.
Collapse
Affiliation(s)
- Mustafa Kucur
- 1 Department of Urology, Batman State Hospital , Batman, Turkey
| | - Serdar Goktas
- 2 Department of Urology, Selcuk University , Konya, Turkey
| | - Mehmet Kaynar
- 2 Department of Urology, Selcuk University , Konya, Turkey
| | - Seza Apiliogullari
- 3 Department of Anesthesia and Intensive Care, Faculty of Medicine, Selcuk University , Konya, Turkey
| | - Ozcan Kilic
- 2 Department of Urology, Selcuk University , Konya, Turkey
| | - Murat Akand
- 2 Department of Urology, Selcuk University , Konya, Turkey
| | - Murat Gul
- 4 Department of Urology, Van Education and Research Hospital , Van, Turkey
| | - Jale Bengi Celik
- 3 Department of Anesthesia and Intensive Care, Faculty of Medicine, Selcuk University , Konya, Turkey
| |
Collapse
|
12
|
Tsuji FH, Chambó RC, Agostinho AD, Trindade Filho JCS, de Jesus CMN. Sedoanalgesia with midazolam and fentanyl citrate controls probe pain during prostate biopsy by transrectal ultrasound. Korean J Urol 2014; 55:106-11. [PMID: 24578806 PMCID: PMC3935066 DOI: 10.4111/kju.2014.55.2.106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 10/11/2013] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To assess the pain intensity of patients administered midazolam and fentanyl citrate before undergoing transrectal ultrasound-guided prostate biopsy. MATERIALS AND METHODS This was a study in patients with different indications for prostate biopsy in whom 5 mg of midazolam and 50 µg of fentanyl citrate was administered intravenously 3 minutes before the procedure. After biopsy, pain was assessed by use of a visual analogue scale (VAS) in three stages: VAS 1, during probe introduction; VAS 2, during needle penetration into prostate tissue; and VAS 3, in the weeks following the exam. Pain intensity at these different times was tested with stratification by age, race, education, prostate volume, rebiopsy, and anxiety before biopsy. Pain was ranked according to the following scores: 0 (no pain), 1-3 (mild pain), 4-7 (moderate pain), and 8-10 (severe pain). Statistical analysis was performed by using Kruskal-Wallis and Wilcoxon two-tailed tests with a significance of 5%. RESULTS Pain intensity was not influenced by any risk factors. The mean VAS 1 score was 1.95±1.98, the mean VAS 2 score was 2.73±2.55, and the mean VAS 3 score was 0.3±0.9, showing greater pain at the time of needle penetration than in other situations (VAS 2>VAS 1>VAS 3, p=0.0013, p=0.0001, respectively). Seventy-five percent of patients reported a VAS pain scale of less than 3.1 or mild pain. CONCLUSIONS Intravenous sedation and analgesia with midazolam and fentanyl citrate is a good method for reducing pain caused by prostate biopsy, even during probe insertion.
Collapse
Affiliation(s)
- Fábio Hissachi Tsuji
- Graduate in Base of Surgery Program, Hospital das Clínicas, Faculdade de Medicina de Botucatu (Unesp), Botucatu, São Paulo, Brazil
| | - Renato Caretta Chambó
- Graduate in Base of Surgery Program, Hospital das Clínicas, Faculdade de Medicina de Botucatu (Unesp), Botucatu, São Paulo, Brazil
| | - Aparecido Donizeti Agostinho
- Department of Urology, Hospital das Clínicas, Faculdade de Medicina de Botucatu (Unesp), Botucatu, São Paulo, Brazil
| | | | | |
Collapse
|
13
|
Jindal T, Mandal SN, Biswas G, Karmakar D. Evaluation of the efficacy of a combination of diltiazem and periprostatic nerve block in pain control during transrectal ultrasonography-guided biopsy of the prostate. Ann R Coll Surg Engl 2013; 95:361-4. [PMID: 23838501 PMCID: PMC4165141 DOI: 10.1308/003588413x13629960046318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2012] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The choice of analgesia during prostate biopsy remains controversial. The pain has dual origin: from the insertion of the probe as well as the biopsy itself. Periprostatic nerve block (PPNB) is currently the gold standard modality for decreasing pain of prostate biopsy but it does not alleviate the pain of probe insertion. A randomised controlled trial was performed to test the efficacy and safety of the combination of topical application of diltiazem gel and PPNB for pain control during transrectal ultrasonography guided prostate biopsy. METHODS A total of 73 patients who were to undergo their first prostate biopsy were randomised to receive either 2ml of 2% topical diltiazem gel or a placebo 15 minutes before the biopsy. All the patients then had a PPNB using 1% lignocaine. A ten- point visual analogue scale was used to record the pain immediately after the insertion of the probe and during the biopsy. Any adverse effects were also recorded. RESULTS There was no significant difference in the mean age and prostate volumes between the groups. There was a significantly lower mean pain score due to probe insertion in those patients who received topical diltiazem than in the placebo group (p<0.0001). There was no significant difference between the pain scores during the biopsy itself between the two groups. CONCLUSIONS Topical diltiazem significantly reduces the pain of probe insertion during prostate biopsy and can be used effectively as an adjuvant to PPNB.
Collapse
Affiliation(s)
- T Jindal
- Department of Urology, Calcutta National Medical College, 32 Gorachand Road, Beniapukur, Kolkata - 700 014, India.
| | | | | | | |
Collapse
|
14
|
Loeb S, Vellekoop A, Ahmed HU, Catto J, Emberton M, Nam R, Rosario DJ, Scattoni V, Lotan Y. Systematic review of complications of prostate biopsy. Eur Urol 2013; 64:876-92. [PMID: 23787356 DOI: 10.1016/j.eururo.2013.05.049] [Citation(s) in RCA: 670] [Impact Index Per Article: 60.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 05/24/2013] [Indexed: 12/11/2022]
Abstract
CONTEXT Prostate biopsy is commonly performed for cancer detection and management. The benefits and risks of prostate biopsy are germane to ongoing debates about prostate cancer screening and treatment. OBJECTIVE To perform a systematic review of complications from prostate biopsy. EVIDENCE ACQUISITION A literature search was performed using PubMed and Embase, supplemented with additional references. Articles were reviewed for data on the following complications: hematuria, rectal bleeding, hematospermia, infection, pain, lower urinary tract symptoms (LUTS), urinary retention, erectile dysfunction, and mortality. EVIDENCE SYNTHESIS After biopsy, hematuria and hematospermia are common but typically mild and self-limiting. Severe rectal bleeding is uncommon. Despite antimicrobial prophylaxis, infectious complications are increasing over time and are the most common reason for hospitalization after biopsy. Pain may occur at several stages of prostate biopsy and can be mitigated by anesthetic agents and anxiety-reduction techniques. Up to 25% of men have transient LUTS after biopsy, and <2% have frank urinary retention, with slightly higher rates reported after transperineal template biopsy. Biopsy-related mortality is rare. CONCLUSIONS Preparation for biopsy should include antimicrobial prophylaxis and pain management. Prostate biopsy is frequently associated with minor bleeding and urinary symptoms that usually do not require intervention. Infectious complications can be serious, requiring prompt management and continued work into preventative strategies.
Collapse
Affiliation(s)
- Stacy Loeb
- Department of Urology, New York University, New York, NY, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|