A Comparative Study among Three Techniques of General Anesthesia for Ultrasound-Guided Transrectal Prostate Biopsy

Abstract

Sedation with propofol alone for biopsy is associated with greater postoperative pain and discomfort than in prostatic plexus block or systemic fentanyl. Besides hypnosis, intraoperative analgesia is required to guarantee postoperative comfort.

The effects of meperidine in patients undergoing deep sedation for transrectal ultrasound-guided prostate biopsy: a randomized, controlled, double-blind study

“…However, we considered deep sedation to be superior because conscious sedation (without analgesia) can result in procedure interruption. Unfortunately, many studies have not reported the total dose of propofol used, whether it was delivered by bolus or continuous infusion, the duration of anesthesia, or the quality of sedation [7,17,18]. In a pilot study, we found that deep sedation could be induced in most patients with a bolus injection of i.v.…”

“…There are two main factors that contribute to pain during a TRUS-PBx are as follows: anal discomfort caused by ultrasound probe insertion, and penetration of the prostatic capsule by the biopsy needle [2]. Although propofol sedation has advantages over a PPNB, it is unable to completely prevent intraprocedural patient movement and postprocedural pain due to lack of analgesic effect [7]. Furthermore, pain during a TRUS-PBx was proven to be gradually accumulated from the first core biopsy to the last, even under anesthesia [19].…”

“…Barbosa et al [7] proposed that propofol 1.5 mg/kg administered with fentanyl 0.5 g/kg, or with PPNB, is significantly more effective for pain control compared to propofol alone, although all approaches resulted in similar BIS values. However, in two cases of propofol administration with fentanyl, respiratory depression was observed, which was reversed by positive-pressure ventilation.…”

“…Deep sedation can achieve sufficient anxiolysis and prevent movement during the procedure, but may also cause adverse side effects. Sedation using propofol is known to promote intraprocedural comfort and increase patient satisfaction [6]; however, sedation using only propofol is unable to completely control all levels of pain intensity during TRUS-PBx [7]. Despite this, some clinicians have suggested that the intensity of pain during TRUS-PBx is tolerable [8], and it remains unverified whether analgesics are required in combination with propofol deep sedation during TRUS-PBx.…”

Itinerário terapêutico de idosos sobreviventes ao câncer

“…Because of this necessary but painful procedure, it is important to make use of analgesia or anesthe-sia to reduce the discomfort and thereby increase the number of samples taken and the success of the procedure. (12) For Family and Determination, this moment was marked by the search for definition of the disease and diagnosis:…”