Procedural sedation and analgesia as an adjunct to periprostatic nerve block for prostate biopsy: A prospective randomized trial

Doğanca, Tünkut; Savsin, Abdurrahman; Erdoğan, Sibel; Altındaş, Fatiş; Özdemir, Fatih; Ekici, Birsel; Öbek, Can

doi:10.1002/jcu.22227

Cited by 8 publications

(12 citation statements)

References 22 publications

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“…Besides, vasovagal performance, such as dizziness, sweating, chest tightness, and shortness of breath, were closely observed. Visual analogue scale (VAS, 0, none; 10, intolerable pain) [ 11 ] and visual numeric scale (VNS, 0, terrible; 4, perfect) [ 12 ] were used to evaluate pain and quantify satisfaction.…”

Section: Methodsmentioning

confidence: 99%

Effect of prostate volume on the peripheral nerve block anesthesia in the prostate biopsy

Luan

Huang²,

Gu³

et al. 2016

Medicine

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Objective:The objective of this study was to evaluate the anesthetic efficacy of periprostatic nerve block (PNB) in transrectal ultrasound (TRUS)-guided biopsy on different prostate volume.Methods:A total of 568 patients received prostate biopsy in our hospital from May 2013 to September 2015 and were retrospectively studied. All patients were divided into local anesthesia group (LAG) and nerve block group (NBG). Then each group was subdivided into 4 subgroups (20–40, 40–60, 60–100, and >100 mL groups) according to different prostate volume range. Visual analogue scale (VAS) and visual numeric scale (VNS) were used to assess the patient's pain and quantify their satisfaction. The scores and complications were compared between the groups.Results:The age and serum prostate-specific antigen (PSA) level before biopsy had no significant differences at intergroup or intragroup level. The VAS scores were significantly lower in the NBG than those in the LAG in terms of prostate volume (1 (1–2) versus 2 (1–3), 2 (1–3) versus 2 (2–4), 2 (2–3) versus 3 (2–5), 4 (3–5) versus 5 (4–7), all P < 0.05). Conversely, the VNS scores were higher in the NBG (4 (3–4) versus 3.5 (3–4), 3 (3–4) versus 3 (3–3), 3 (2–4) versus 3 (2–3), 2 (2–2) versus 1 (1–2), all P < 0.05). Patients with smaller prostate volume undergoing PNB or local anesthesia experienced significantly lower pain and higher satisfaction scores than those with large prostate. Whether in PNB or local anesthesia group, patients with large prostate volume had more chance to have hematuria, hemospermia, urinary retention than smaller one except infection (P < 0.05). Those complications had no significant differences between LAG and NBG (P > 0.05).Conclusion:Compared with local anesthesia, ultrasound-guided PNB has superior analgesic effect and equal safety, but for patients with a large prostate volume, the analgesic effect is inefficient.

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Section: Methodsmentioning

confidence: 99%

Effect of prostate volume on the peripheral nerve block anesthesia in the prostate biopsy

Luan

Huang²,

Gu³

et al. 2016

Medicine

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“…REMI infusion by syringe pump with midazolam has been administrated to offer PAS for TRUS-guided prostate biopsy and breast biopsies. [2,11] However, to the best of our knowledge, there are no data on the use of TCI of REMI with midazolam in TRUS-guided prostate biopsy under PAS. Here, we first reported that REMI Ce of 2.0 µg/mL by TCI pump with 3 to 4 mg midazolam and intrarectal lidocaine gel use provided adequate analgesia and sedation, appropriate hemodynamic conditions, acceptable adverse events (apnea with desaturation; SpO 2 88%–89%), and better surgeon satisfaction in TRUS-guided prostate biopsy under PAS as our previous research in percutaneous transluminal balloon angioplasty for dysfunctional hemodialysis fistulas.…”

Section: Discussionmentioning

confidence: 99%

“…Doğanca et al [2] reported that REMI infusion by syringe pump was successfully used in combination with midazolam in TRUS-guided prostate biopsy under PAS. [2] Until now, there is limited data on the use of TCI of REMI with midazolam in TRUS-guided prostate biopsy under PAS. In our previous study, we showed that TCI with REMI Ce of 2.0 ng/mL and 3 to 4 mg midazolam use provided appropriate hemodynamic and respiratory conditions, and sufficient analgesia and sedation under PAS in percutaneous transluminal balloon angioplasty for dysfunctional hemodialysis fistulas.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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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.Abbreviations: ANI = analgesia nociception index, BIS = bispectral index, Ce = effect-site concentration, EtCO 2 = endtidal carbon dioxide pressure, HR = heart rate, MAP = mean arterial pressure, OAA/S = Observer's Assessment of Alertness/ Sedation, PACU = postanesthesia care unit, PAS = procedural analgesia and sedation, PNB = periprostatic nerve block, PONV = postoperative nausea and vomiting, REMI = remifentanil, SBP = systolic blood pressure, SpO 2 = peripheral oxygen saturation, TCI = target-controlled infusion, TRUS = transrectal ultrasound, TSGH = Tri-Service General Hospital.

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“…Pain was evaluated by the visual analog scale (VAS; 0, none; 10, intolerable pain), and satisfaction was quantified using a visual numeric scale (VNS; 0, terrible; 4, perfect); only integers were allowed [23, 24]. Another independent resident and the patients were ‘blinded’ to the type of anesthesia given.…”

Section: Methodsmentioning

confidence: 99%

Pelvic plexus block to provide better anesthesia in transperineal template-guided prostate biopsy: a randomised controlled trial

Ding

Huang

et al. 2019

BMC Urol

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Background To evaluate the efficacy of pelvic plexus block (PPB) in relief pain during transperineal template-guided prostate biopsy (TTPB), compared with conventional periprostatic nerve block (PNB). Methods From July 2016 to August 2017, 245 patients who were performed TTPB in Clinical Medical College of Yangzhou University were recruited. The patients were randomized into three groups using a random number table. Group-1 received prostate capsule local anesthesia with 22 ml of 1% lidocaine. Group-2 additionally received PNB on the basis of Group-1. To perform PNB, 5 ml 1% lidocaine was injected into the region of prostatic neurovascular bundle situated in the angle of prostate-bladder-seminal vesicle. Group-3 received prostate capsule local anesthesia plus PPB (5 ml of 1% lidocaine injection into the pelvic plexus which located on lateral to the bilateral seminal vesicle apex). The patients’ pain and satisfaction were evaluated by visual analogue scale and visual numerical scale, respectively. Results The age, total prostate volume, PSA and the number of cores were comparable among the three groups. The visual analog scale scores of group-3 were significantly lower than group-2 during biopsy ( P = 0.003). Conversely, the visual numeric scale scores were higher in group-3 ( P = 0.039). Both the group-2 and group-3 outperformed the group-1 in alleviating pain and had a higher quantification of satisfaction. There were no significant differences in the pain scores or the satisfaction scores at 30 min after the procedure among the three groups. Conclusions The analgesic efficacy of PPB guided by Doppler ultrasound in TTPB was better than that of PNB and both were superior to no nerve block. Trial registration ChiCTR-IOR-17013533 , 01/06/2016.

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Procedural sedation and analgesia as an adjunct to periprostatic nerve block for prostate biopsy: A prospective randomized trial

Abstract: PSAA with midazolam and remifentanil used as an adjunct to the standard PNB is safe and effective during TRUS-PB. Patients undergoing PSAA in addition to PNB experienced significantly less pain and higher satisfaction scores than did those given PNB alone.

Cited by 8 publications

References 22 publications

Effect of prostate volume on the peripheral nerve block anesthesia in the prostate biopsy

Effect of prostate volume on the peripheral nerve block anesthesia in the prostate biopsy

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

Pelvic plexus block to provide better anesthesia in transperineal template-guided prostate biopsy: a randomised controlled trial

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