title: Sedoanalgesia with midazolam and fentanyl citrate controls probe pain during prostate biopsy by transrectal ultrasound.
abstract: OBJECTIVE
  To assess the pain intensity of patients administered midazolam and fentanyl citrate before undergoing transrectal ultrasound-guided prostate biopsy.
  
  
  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.
authors.affiliation: Graduate in Base of Surgery Program, Hospital das Clínicas, Faculdade de Medicina de Botucatu (Unesp), Botucatu, São Paulo, Brazil.
authors.forename: Fábio Hissachi
authors.initials: FH
authors.lastname: Tsuji
authors.affiliation: Graduate in Base of Surgery Program, Hospital das Clínicas, Faculdade de Medicina de Botucatu (Unesp), Botucatu, São Paulo, Brazil.
authors.forename: Renato Caretta
authors.initials: RC
authors.lastname: Chambó
authors.affiliation: Department of Urology, Hospital das Clínicas, Faculdade de Medicina de Botucatu (Unesp), Botucatu, São Paulo, Brazil.
authors.forename: Aparecido Donizeti
authors.initials: AD
authors.lastname: Agostinho
authors.affiliation: Department of Urology, Hospital das Clínicas, Faculdade de Medicina de Botucatu (Unesp), Botucatu, São Paulo, Brazil.
authors.forename: José Carlos Souza
authors.initials: JC
authors.lastname: Trindade Filho
authors.affiliation: Department of Urology, Hospital das Clínicas, Faculdade de Medicina de Botucatu (Unesp), Botucatu, São Paulo, Brazil.
authors.forename: Carlos Márcio Nóbrega
authors.initials: CM
authors.lastname: de Jesus
keywords: Anesthesia and analgesia; Needle biopsy; Pain measurement; Prostate