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Hamouda A, Ibrahim A, Corsi N, Siena G, Elterman DS, Chughtai B, Bhojani N, Sessa F, Rivetti A, Secco S, Zorn KC. Use of the Schelin Catheter for transurethral intraprostatic anesthesia prior to Rezūm treatment. Can J Urol 2024; 31:11802-11808. [PMID: 38401260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2024]
Abstract
Minimally invasive surgery techniques (MIST) have become newly adopted in urological care. Given this, new analgesic techniques are important in optimizing patient outcomes and resource management. Rezūm treatment (RT) for BPH has emerged as a new MIST with excellent patient outcomes, including improving quality of life (QoL) and International Prostate Symptom Scores (IPSSs), while also preserving sexual function. Currently, the standard analgesic approach for RT involves a peri-prostatic nerve block (PNB) using a transrectal ultrasound (TRUS) or systemic sedation anesthesia. The TRUS approach is invasive, uncomfortable, and holds a risk of infection. Additionally, alternative methods such as, inhaled methoxyflurane (Penthrox), nitric oxide, general anesthesia, as well as intravenous (IV) sedation pose safety risks or mandate the presence of an anesthesiology team. Transurethral intraprostatic anesthesia (TUIA) using the Schelin Catheter (ProstaLund, Lund, Sweden) (SC) provides a new, non-invasive, and efficient technique for out-patient, office based Rezūm procedures. Through local administration of an analgesic around the prostate base, the SC has been shown to reduce pain, procedure times, and bleeding during MISTs. Herein, we evaluated the analgesic efficacy of TUIA via the SC in a cohort of 10 patients undergoing in-patient RT for BPH.
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Affiliation(s)
- Aalya Hamouda
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Ahmed Ibrahim
- Division of Urology, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - Nicholas Corsi
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Giampaolo Siena
- Department of Urology, University of Florence, Careggi, Florence, Italy
| | - Dean S Elterman
- Division of Urology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York Presbyterian, New York, New York, USA
| | - Naeem Bhojani
- Division of Urology, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - Francesco Sessa
- Department of Urology, University of Florence, Careggi, Florence, Italy
| | - Anna Rivetti
- Department of Urology, University of Florence, Careggi, Florence, Italy
| | - Silvia Secco
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Kevin C Zorn
- Division of Urology, University of Montreal Hospital Center, Montreal, Quebec, Canada
- BPH Canada Prostate Center, Mont-Royal Surgical Center, Montreal, Quebec, Canada
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Hamouda A, Ibrahim A, Corsi N, Elterman DS, Chughtai B, Bhojani N, Zorn KC. Peri-prostatic nerve block using Clarius EC7 HD₃ handheld ultrasound guidance. Can J Urol 2023; 30:11741-11746. [PMID: 38104332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Transrectal ultrasound (TRUS) is a common modality used during urological procedures that require real-time visualization of the prostate, such as prostate biopsy and peri-prostatic nerve blocks (PNB) for surgical procedures. Current practice for TRUS-guided PNB requires use of costly, fixed, and non-portable ultrasound machinery that can often limit workflow. The Clarius endocavity EC7 probe, a digital, handheld and pocket-sized endocavity ultrasound (US) device, is an alternative, portable technology which was recently shown to accurately visualize and measure prostate dimensions and volume. Moreover, in recent years, there has been a renaissance of office-based treatments for minimally invasive surgical therapies (MIST) for the treatment of benign prostate hyperplasia (BPH). More specifically, the Rezūm procedure has been demonstrated to offer men a short, outpatient therapy with excellent 5-year outcomes in durability and preservation of antegrade ejaculation. While other anesthetic techniques have been described for Rezūm, including inhaled methoxyflurane (Penthrox), nitrous oxide, IV sedation and general anesthesia (which often mandate the presence of an anesthesiology team), US-guided local blocks offer the urologist an independent method for pain management. While most urologists may not have direct access to expensive, cart-based ultrasound systems, point of care ultrasound (POCUS) technology, such as Clarius (Vancouver, BC, Canada) and Butterfly (Butterfly Network, Inc, Guilford, CT, USA), can provide high-resolution imaging in combination with smart phone technology. Herein, we sought to describe the technique for using Clarius EC7 for TRUS-guided PNB and its use in urological application with the Rezūm BPH procedure.
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Affiliation(s)
- Aalya Hamouda
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Ahmed Ibrahim
- Division of Urology, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - Nicholas Corsi
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Dean S Elterman
- Division of Urology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York Presbyterian, New York, New York, USA
| | - Naeem Bhojani
- Division of Urology, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - Kevin C Zorn
- Division of Urology, University of Montreal Hospital Center, Montreal, Quebec, Canada
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Del Toro-Pagán NM, Dai F, Banack T, Berlin J, Makadia SA, Rubin LE, Zhou B, Huynh P, Li J. Perineural Methylprednisolone Depot Formulation Decreases Opioid Consumption After Total Knee Arthroplasty. J Pain Res 2022; 15:2537-2546. [PMID: 36061486 PMCID: PMC9432382 DOI: 10.2147/jpr.s378243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/15/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Opioid consumption after total knee arthroplasty (TKA) remains a challenge with single injection nerve blocks even with common local anesthetic adjuvants dexamethasone (DEX). This study aimed to investigate the effects of adding methylprednisolone acetate (MPA) to adductor canal blocks (ACB) and interspace between the popliteal artery and capsule of the posterior knee (iPACK) blocks on postoperative opioid consumption. Methods A retrospective analysis was conducted on 100 consecutive TKA patients equally assigned into two groups, with one group receiving DEX through ACB and iPACK block and the other group receiving DEX and methylprednisolone acetate (DEX/MPA) through the same nerve blocks. The primary outcome was cumulative opioid consumption (oral milligram morphine equivalent, OME) during hospitalization for up to three days. Secondary outcomes included daily opioid consumption, highest rest and active pain scores, prosthetic knee joint active range of motion (AROM), laboratory studies including fasting serum glucose (FSG) and white blood cell count (WBC) on each postoperative day (POD), and length of hospital stay. Results Cumulative opioid consumption was significantly lower in the DEX/MPA group vs DEX group (median difference (95% CI) = -45.3 (-80.5 to -10), P = 0.011). The highest rest and active pain scores were both significantly lower in the DEX/MPA group than in DEX group on POD 2 (least square mean difference (95% CI) = -1.3 (-2.3 to -0.4), P = 0.005 and -0.9 (-1.8 to -0.1), P = 0.031, respectively). Except on POD 1, FSG values were significantly lower in the DEX/MPA group (median difference (95% CI) = -22.5 (-36 to -8.9), P = 0.001). AROM, WBC, and length of stay were comparable between both groups. Conclusion Compared to perineural DEX alone, the addition of MPA further decreases postoperative opioid consumption without clinically significant changes on FSG and WBC. Level of Evidence III.
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Affiliation(s)
- Nicole M Del Toro-Pagán
- Department of Pharmacy, Yale New Haven Health - Bridgeport Hospital, Bridgeport, CT, USA,Applied Precision Pharmacotherapy Institute, Tabula Rasa HealthCare, Moorestown, NJ, USA
| | - Feng Dai
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT, USA
| | - Trevor Banack
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA
| | - Jill Berlin
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA
| | - Satya A Makadia
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA
| | - Lee E Rubin
- Department of Orthopedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Bin Zhou
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT, USA
| | - Phu Huynh
- Department of Pharmacy, Yale New Haven Hospital, New Haven, CT, USA
| | - Jinlei Li
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA,Correspondence: Jinlei Li, Department of Anesthesiology, Yale University School of Medicine, 333 Cedar Street, PO Box 208051, New Haven, CT, 06520-8051, USA, Tel + 1 475 434 4038, Email
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Gagne OJ, Cheema A, Abuhantash M, Ree R, Penner M, Wing K, Younger A, Salat P, Veljkovic A. Effect of Dexamethasone in Peripheral Nerve Blocks on Recovery of Nerve Function. Foot Ankle Int 2021; 42:23-30. [PMID: 32964737 DOI: 10.1177/1071100720952075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Peripheral nerve blocks (PNBs) have revolutionized distal extremity surgery reducing pain and improving hospital efficiency. Perineural dexamethasone has been administered with PNBs to prolong their effects, although the safety of dexamethasone has not been established in the literature. This study aimed to determine if the addition of dexamethasone affected the postoperative neurological sensory status for foot and ankle surgeries and the recovery of nerve injuries. We hypothesized that the rate of persistent nerve injury would be higher in the dexamethasone group. METHODS This is a retrospective observational cohort study of prospectively collected data of all patients from a single foot and ankle surgeon's practice. Perineural dexamethasone was routinely used as an adjunct by the regional anesthesia group until a clinical trend of increased paresthesia was found on short-term follow-up, which led to the discontinuation of its use. In this study, the cohort that received dexamethasone with ropivacaine was compared with the cohort that received ropivacaine alone. The primary outcome was a separate sensory nerve status sheet that was completed for every distal nerve territory for every patient at their follow-up visits at 2 weeks, 6 weeks, 3 months, and 6 months. Univariate analysis and a logistic regression model were used to determine the association between dexamethasone and delayed nerve recovery. A total of 250 patients were included in the study, with 117 patients in the dexamethasone group and 133 in the ropivacaine-only group. RESULTS The rates of nerve injuries were not different between the groups (72 [62%] in the dexamethasone group vs 79 [59%] in the ropivacaine-only group). However, nerve injury symptoms were more likely to persist and not fully recover in the dexamethasone group (n = 47, 65%) compared with the ropivacaine-only group (n = 32, 41%) (OR, 2.12; P = .006). CONCLUSION Perineural dexamethasone added to PNBs may be associated with delayed nerve recovery after foot and ankle surgery. It may be prudent to avoid its use until its full safety profile is established in larger prospective trials. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Oliver J Gagne
- Department of Orthopedics, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amar Cheema
- Department of Orthopedics, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Monther Abuhantash
- Department of Orthopedics, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ron Ree
- Department of Anesthesiology, Perioperative Medicine, and Pain Management, The Heart Centre, Providence Health Care, Vancouver, British Columbia, Canada
| | - Murray Penner
- Department of Orthopedics, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kevin Wing
- Department of Orthopedics, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alastair Younger
- Department of Orthopedics, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter Salat
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Andrea Veljkovic
- Department of Orthopedics, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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Issa MM, Al-Qassab UA, Hall J, Ritenour CWM, Petros JA, Sullivan JW. Formalin disinfection of biopsy needle minimizes the risk of sepsis following prostate biopsy. J Urol 2013; 190:1769-75. [PMID: 23714433 DOI: 10.1016/j.juro.2013.04.134] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE We describe a simple and effective method to reduce the risk of infection after prostate biopsy. MATERIALS AND METHODS A total of 1,642 consecutive prostate biopsy procedures during a 4-year period (2008 to 2012) were included in the study. Inclusion criteria consisted of pre-biopsy negative urine culture, bisacodyl enema and fluoroquinolone antibiotics (3 days). Formalin (10%) was used to disinfect the needle tip after each biopsy core. All patients were monitored for post-biopsy infection. The rate of infection was compared to that of a historical series of 990 procedures. Two ex vivo experiments were conducted to test the disinfectant effectiveness of formalin against fluoroquinolone resistant Escherichia coli, and another experiment was performed to quantitate formalin exposure. RESULTS Post-biopsy clinical sepsis with positive urine and blood cultures (quinolone resistant E. coli) developed in 2 patients (0.122%). Both patients were hospitalized, treated with intravenous antibiotics and had a full recovery without long-term sequelae. Mild uncomplicated urinary infection developed in 3 additional patients (0.183%). All were treated with outpatient oral antibiotics and had a complete recovery. The overall rate of urinary infection and sepsis using formalin disinfection was approximately a third of that of a prior series (0.30% vs 0.80%, p=0.13). Ex vivo experiments showed a complete lack of growth of fluoroquinolone resistant E. coli on blood and MacConkey agars after exposure to formalin. The amount of formalin exposure was negligible and well within the safe parameters of the Environmental Protection Agency. CONCLUSIONS Formalin disinfection of the biopsy needle after each prostate biopsy core is associated with a low incidence of urinary infection and sepsis. This technique is simple, effective and cost neutral.
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Affiliation(s)
- Muta M Issa
- Department of Urology, Veterans Affairs Medical Center, Atlanta, Georgia; Emory University School of Medicine, Atlanta, Georgia.
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