title: Procedural sedation and analgesia as an adjunct to periprostatic nerve block for prostate biopsy: A prospective randomized trial.
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.
authors.affiliation: Department of Urology, Suluova State Hospital, Amasya, Turkey.
authors.forename: Tünkut
authors.initials: T
authors.lastname: Doğanca
authors.forename: Abdurrahman
authors.initials: A
authors.lastname: Savsin
authors.forename: Sarper
authors.initials: S
authors.lastname: Erdoğan
authors.forename: Fatis
authors.initials: F
authors.lastname: Altindas
authors.forename: Fatih
authors.initials: F
authors.lastname: Özdemir
authors.forename: Birsel
authors.initials: B
authors.lastname: Ekici
authors.forename: Can
authors.initials: C
authors.lastname: Öbek
mesh_terms: D000368:Aged; D000779:Anesthetics, Local; D001706:Biopsy; D005782:Gels; D006801:Humans; D006993:Hypnotics and Sedatives; D008012:Lidocaine; D008297:Male; D008874:Midazolam; D008875:Middle Aged; D009407:Nerve Block; D010146:Pain / Q000517:prevention & control*; D017060:Patient Satisfaction; D010880:Piperidines; D011446:Prospective Studies; D011467:Prostate / Q000000981:diagnostic imaging* / Q000473:pathology*; D000077208:Remifentanil; D018084:Ultrasonography, Interventional
chemical_list: D000779:Anesthetics, Local; D005782:Gels; D006993:Hypnotics and Sedatives; D010880:Piperidines; D008012:Lidocaine; D000077208:Remifentanil; D008874:Midazolam
keywords: analgesia; anesthesia; procedural sedation; transrectal utrasound-guided prostate biopsy; ultrasonography