New In Press UroToday Int J. 2009 In Press. doi:10.3834/uij.1944-5784.2009.12.04
Patient Response to Total Intravenous Sedation (TIVS) for Outpatient Ultrasound-Guided Prostate Biopsy
INTRODUCTION: Transrectal ultrasound (TRUS) guided biopsy is a common office urology procedure. Pain or discomfort associated with this procedure has been addressed with the use of periprostatic or intraprostatic infiltration and nerve block, local anesthesia, general anesthesia, suppository or oral analgesia, or lidocaine gel. The present study is an investigation of patient response to total intravenous sedation (TIVS) for TRUS-guided prostate biopsy. The authors describe the steps of the TIVS technique and critically examine the subsequent intraoperative and postoperative effects.
METHODS: Between December 2006 and April 2007, 100 patients underwent TRUS-guided prostate biopsy by a single surgeon (RK). TIVS sedation was achieved by intravenous administration of fentanyl (0.5-2 μg/kg), midazolam (0.03-0.05 mg/kg) and propofol (dosage titrated). Patients completed a modified Aldrete scoring system and modified postanesthetic discharge scoring system. The quality of the analgesia was assessed with a numerical pain rating scale. Patients were given a questionnaire to assess their perception of the pain and tolerability of the procedure.
RESULTS: The mean time between introduction of the probe and the end of the procedure was 10.5 minutes. Mean sedation time was 19 minutes and all patients were ready for discharge 70 minutes after the procedure. A total of 95 patients experienced a mild pain score of 1-3 out of 10 shortly after the procedure. The mean pain intensity score (95% Confidence Interval) was 1.36 (1.19-1.54), standard deviation = 0.865, median = 1. One patient developed intense nausea requiring IV antiemetic therapy. One patient developed urinary retention requiring urinary catheterization for a few days. There were no other complications related to the TIVS or TRUS procedure. Ninety-eight percent of the patients stated that they were not reluctant to have the biopsy repeated in the future if it was necessary.
CONCLUSIONS: TRUS-guided biopsy of the prostate can be accomplished with minimal pain by using TIVS. The authors believe that sedation should be considered and discussed with patients. TIVS provided sufficient analgesia and satisfactory hemodynamic stability. These effects facilitated recovery, allowing patients to be discharged less than 2 hours after the procedure.
KEYWORDS: Transrectal ultrasound; Biopsy of prostate; Procedural intravenous sedation (PIS); Total intravenous sedation (TIVS); Modified Aldrete scoring system, Modified postanesthetic discharge score
CORRESPONDENCE: Dr. Ahmed Al-Sameraaii, Department of Urology, The St. George Hospital, Gray Street, Kogarah 2217, NSW, Australia (ahmedalsameraaii@hotmail.comThis email address is being protected from spam bots, you need Javascript enabled to view it ).
CITATION: UroToday Int J. 2009 Dec;2(6). doi:10.3834/uij.1944-5784.2009.12.04
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