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Sedoanalgesia With Midazolam and Fentanyl Citrate Controls Probe Pain During Prostate Biopsy by Transrectal Ultrasound

대한비뇨기과학회지 2014년 55권 2호 p.106 ~ 111
 ( Tsuji Fabio Hissachi ) - Faculdade de Medicina de Botucatu (Unesp) Graduate in Base of Surgery Program Hospital das Clinicas

 ( Agostinho Aparecido Donizeti ) - Sao Paulo University Medical School Hospital das Clinicas Division of Urology
 ( Filho Jose Carlos Souza Trindade ) - Sao Paulo University Medical School Hospital das Clinicas Division of Urology
 ( Jesus Carlos Marcio Nobrega de ) - Sao Paulo University Medical School Hospital das Clinicas Division of Urology
 ( Chambo Renato Caretta ) - Faculdade de Medicina de Botucatu (Unesp) Graduate in Base of Surgery Program Hospital das Clinicas

Abstract


Purpose: To assess the pain intensity of patients administered midazolam and fentanyl citrate before undergoing transrectal ultrasound-guided prostate biopsy.

Materials and 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.

키워드

Anesthesia and analgesia; Needle biopsy; Pain measurement; Prostate
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