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Procedural sedation and analgesia as an adjunct to periprostatic nerve block for prostate biopsy: A prospective randomized trial
Author(s) -
Doğanca Tünkut,
Savsin Abdurrahman,
Erdoğan Sarper,
Altindas Fatis,
Özdemir Fatih,
Ekici Birsel,
Öbek Can
Publication year - 2015
Publication title -
journal of clinical ultrasound
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.272
H-Index - 61
eISSN - 1097-0096
pISSN - 0091-2751
DOI - 10.1002/jcu.22227
Subject(s) - medicine , lidocaine , sedation , anesthesia , nerve block , randomized controlled trial , midazolam , anesthesiology , visual analogue scale , prostate biopsy , prostate , prospective cohort study , patient satisfaction , surgery , cancer
ABSTRACT Background To assess whether patient comfort could be increased by adding procedural sedation and analgesia (PSAA) to periprostatic nerve block (PNB) in patients undergoing transrectal ultrasound‐guided prostatic biopsy (TRUS‐PB). Methods This was a prospective, randomized (1:2) trial comparing PNB with the combination of PSAA+PNB in patients undergoing TRUS‐PB. PNB was achieved by using lidocaine gel and lidocaine and bipuvacaine infiltration. PSAA‐treated patients received midazolam and remifentanil. All biopsies were standardized and performed in a fully equipped endourology suite. PSAA was delivered by an anesthesiology nurse in the presence and availability of an anesthesiologist. An orally administered numeric scale of 0–10 was used to assess the patient's pain, and a visual scale of 0–4 was used to quantify their satisfaction. Pain and satisfaction scores were compared between the groups. Results Data on 331 patients were analyzed: 235 received PNB, and 96 received PSAA+PNB. Distribution within the groups by age, prostate‐specific antigen serum levels, prostate volume, and number of cores obtained was similar. Airway insertion was required in 4 of 96 patients in PSAA+PNB arm (4%), with no other complications related to sedation. The average pain level was significantly lower in the PSAA+PNB group than it was in the PNB group (0.88 versus 1.31; p = 0.008). The satisfaction level was high (3.5) and alike in the two groups; however, significantly more patients reported a perfect score of 4 in the PSAA+PNB arm ( p = 0.03). Conclusions 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. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 43:288–294, 2015